Simulation Training for Laparoscopic Surgery Can Improve Minimally Invasive Surgical Techniques for Interns and Probationers

Objective: The clinical clerkship and practice stage plays a pivotal role in the transition of medical students from theoretical knowledge to practical application, bridging the gap between classroom learning and real-life clinical experience. In order to improve the teaching quality of interns and probationers, we try to let them practice the skills of laparoscopic surgery in the early stage, and summed up a set of evaluation methods that can be widely used in medical education. Methods: From September 2019 to December 2019, a total of 54 interns and 72 trainees were selected as research objects. They were assigned to training sessions and their proficiency was assessed before and after the training. The change in proficiency is compared to determine whether the training course is valuable. Results: Before the operation training, the interns scores were BP 17.3 3.1, CC 17.9 3.4, KT 16.4 3.4, LS 16.7 3.3. The results of probationers were BP 16.9 2.7, CC 16.8 2.8, KT 15.2 1.6, and LS 14.8 2.2. After completing the operations training, the results of interns were BP 21.1 1.9, CC 20.6 2.7, KT 19.6 3.0, and LS 20.9 1.4. The probationers scores were BP 19.3 3.2, CC 19.6 3.5, KT 19.6 2.6, and LS 20.0 2.4. After the operation training, the performance of the intern group was better than that before the training (P < 0.05). The same is true of the probationer group. The time-consuming intern examinations were BP 147.9 38.5 s, CC 123.2 28.7 s, KT 82.6 24.1 s and LS 162.5 31.1 s. The examination time of probationers were BP 179.9 46.4 s, CC 132.1 24.3 s, KT 109.3 27.5 s and LS 210.0 58.8 s. Conclusion: Simulation training for laparoscopic surgery can improve minimally invasive surgical techniques for interns and probationers.

Research on the Dual-Creation Talent Training Model of New Energy Automobile Based on Virtual Simulation

At present,as China vigorously develops new energy automobiles,the social demand for related talents has increased significantly,so the relevant institutions need to optimize and adjust the talent training mode to help the development of new energy automobiles.This paper summarizes the existing problems of China’s new energy automobile talent training mode,and analyzes the significance of the virtual simulation-based dual-creation talent training mode of new energy automobile and its specific implementation strategies,in order to provide references for the relevant personnel.

Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.

Interactive plant simulation modeling for developing an operator training system in a natural gas pressure-regulating station

This study proposes a method of interactive plant simulation modeling which delivers the online simulated results to the field operators and induces them to take proper actions in the case of pre-identified accident scenarios in a chemical plant. The developed model integrates the real-time process dynamic simulation with 3DCFD accident simulation in a designed interface using object linking and embedding technology so that it can convey to trainees the online information of the accident which is not available in existing operator training systems.The model encompasses the whole process of data transfer till the end of the training at which a trainee operates an emergency shutdown system in a programmed model. In this work, an overall scenario is simulated which is from an abnormal increase in the main valve discharge（second）pressure due to valve malfunction to accidental gas release through the crack of a pressure recorder, and the magnitude of the accident with respect to the lead time of each trainee＇s emergency response is analyzed. The model can improve the effectiveness of the operator training system through interactively linking the trainee actions with the simulation model resulting in different accident scenarios with respect to each trainee＇s competence when facing an accident.

Virtual reality simulation in training endoscopic skills: A systematic review

Objective:Training young physicians in gastrointestinal endoscopy through virtual reality(VR)simulators has become popular.It is important to evaluate the benefits and usefulness of this technology for teaching endoscopic skills.The objective of this literature review is to understand the benefits of VR technology through quantitative and qualitative examination of learning outcomes.Methods:A literature search of 7 databases was conducted.Studies which compared the effects of learning through VR simulation and another method of learning were included.In addition,studies were included if they evaluated learning outcomes on clinical patients.Participants could be medical residents,fellows,physicians,or nurses.Common outcomes measured across studies included subjective overall performance scores,total procedure times,rate of successful procedure completion,error rates,patient pain or discomfort,and measures of independence.Results:A total of 22 studies were included.Overall,VR simulation training was seen to be comparable or significantly better than clinical training,no training,other types of simulation,and another form of VR training.Many authors reported increasing patient safety,reducing stress and time constraints,and shortening the learning curve as advantages of VR simulation training.However,this form of training is also expensive and may result in the learning of bad habits.Conclusion:VR simulation technology can be a valuable form of educating endoscopy novices if properly supervised during training,and if there is also integration of clinical training.

The Research and Development of Integrated Operation-Maintenance Simulation Training System

With deep development of state grid’s system of "Three Sets of Five [1]", China is in urgent need of establishing an appropriate type of simulation system to rapidly improve operation efficiency and the level of maintainers, which aim at the integrated operation of substation operation and maintenance service. This article gives an introduction of a simulation training system which is designed for operation-skills training in electrical systems. By the composition of the multiple subjects and skills training for operations staff, this system can provide human guarantee and intellectual support for the "Big-Centralized Overhal".

Understanding the effects of structured self-assessment in directed,self-regulated simulation-based training of mastoidectomy:A mixed methods study

Objective:Self-directed training represents a challenge in simulation-based training as low cognitive effort can occur when learners overrate their own level of performance.This study aims to explore the mechanisms underlying the positive effects of a structured self-assessment intervention during simulation-based training of mastoidectomy.Methods:A prospective,educational cohort study of a novice training program consisting of directed,self-regulated learning with distributed practice(5x3 procedures)in a virtual reality temporal bone simulator.The intervention consisted of structured self-assessment after each procedure using a rating form supported by small videos.Semi-structured telephone interviews upon completion of training were conducted with 13 out of 15 participants.Interviews were analysed using directed content analysis and triangulated with quantitative data on secondary task reaction time for cognitive load estimation and participants’self-assessment scores.Results:Six major themes were identified in the interviews:goal-directed behaviour,use of learning supports for scaffolding of the training,cognitive engagement,motivation from self-assessment,selfassessment bias,and feedback on self-assessment(validation).Participants seemed to self-regulate their learning by forming individual sub-goals and strategies within the overall goal of the procedure.They scaffolded their learning through the available learning supports.Finally,structured self-assessment was reported to increase the participants’cognitive engagement,which was further supported by a quantitative increase in cognitive load.Conclusions:Structured self-assessment in simulation-based surgical training of mastoidectomy seems to promote cognitive engagement and motivation in the learning task and to facilitate self-regulated learning.

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation:a Delphi consensus study

Objective:This study is aimed to develop student simulated patient(SSP)training content and evaluation indicators,and further explores their validity and reliabilities.Methods:Delphi consultations with 20 nursing exper ts were conducted.The weights of indicators were calculated through the analytic hierarchy process.SSP training was conducted with a high-fidelity nursing simulation.Results:The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation.The expert authority coefficient was reported as 0.87.The training included role and responsibility of simulated patient(SP),script interpretation,plot performance,and training for a rater,with a total of 17 indicators.SSP evaluation consisted of disease knowledge,role portrayal,and performance fidelity and since being a rater,it consists of 20 indicators in total.The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918.The content validity of SSP evaluation indicators was 0.95.The inter-rater reliability was repor ted as 0.866,and the internal consistency established using Cronbach’sαwas 0.727.Conclusions:Students as SPs should have first-hand knowledge and experience within the simulated scenarios.SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process.The evaluation indicators were valid and reliable,and provided the objective and quantifiable measurements for SSP training in nursing。

Training, simulation, restoration expert system for power grid

The paper introduces some technology for training, simulation, restoration expert system of power grid, the structure of the system including function composition, hardware and software composition are discussed, knowledge representation and the method to establish device graphical library for expert system are given, the fault setting and diagnosis for training and simulation as well as restoration technology with deep first searching arithmetic and heuristic inference are presented. The research provides a good base for developing the training, simulation, restoration system of power companies.

URAV Simulation Training System Based on Aerosim and Google Earth

In order to solve the difficulties of traditional simulation training method on unmanned reconnaissance aerial vehicle, such as the low environment fidelity, difficulty of modeling and long cycle of development, a simulation training method based on Google Earth is put forward. The 6-DOF motion system of URAV is established through Matlab/Simulink. The visual simulation environment which is close to real scenes is formed though GE and software of SketchUp, and the visualization of flight data and elevation information of the region are also obtained through the software of GMS Aircraft Instrument and Measurement Studio. Experiments show that the method has satisfactory effects and its functions also can be strengthened, therefore it provides reference to related researchers.

Simulation-based mastery learning in gastrointestinal endoscopy training

Simulation-based mastery learning(SBML)is an emerging form of competencybased training that has been proposed as the next standard method for procedural task training,including that in gastr-ointestinal endoscopy.Current basic gastrointestinal endoscopy training relies on the number of procedures performed,and it has been criticized for its lack of objective standards that result in variable skills among trainees and its association with patient safety risk.Thus,incorporating simulators into a competency-based curriculum seems ideal for gastrointestinal endoscopy training.The curriculum for SBML in gastrointestinal endoscopy is currently being developed and has promising potential to translate into the clinical performance.Unlike the present apprenticeship model of“see one,do one,teach one,”SBML integrates a competency-based curriculum with specific learning objectives alongside simulation-based training.This allows trainees to practice essential skills repeatedly,receive feedback from experts,and gradually develop their abilities to achieve mastery.Moreover,trainees and trainers need to understand the learning targets of the program so that trainees can focus their learning on the necessary skills and trainers can provide structured feedback based on the expected outcomes.In addition to learning targets,an assessment plan is essential to provide trainees with future directions for their improvement and ensure patient safety by issuing a passing standard.Finally,the SBML program should be planned and managed by a specific team and conducted within a developed and tested curriculum.This review discusses the current state of gastr-ointestinal endoscopy training and the role of SBML in that field.

The Relationship between Presence and Performance in Virtual Simulation Training

The use of virtual simulation-based training continues to expand, as organizations explore alternative methods to reduce the cost of training. While virtual simulation has been empirically validated to be effective in the transfer of skills to the live environment, what is still unknown is what effect, if any, that an individual’s sense of presence in the simulation has on their performance. In this paper, we examine the relationship between presence and performance while performing a psychomotor task in a virtual environment. The independent variables were visual display and expertise level. The dependent variables were presence and performance. We found evidence of a moderate relationship between the degree of presence experienced in the simulation and an individual’s performance over three training trials. Results of this study may inspire future research to investigate whether higher presence in virtual simulation results in higher performance.

Developments in Simulation Bronchoscopy Training

Flexible bronchoscopy is a common procedure. Training in bronchoscopy is a complex process involving learning technical skills, understanding indications and contraindications, risks and benefits of the procedure, working within the team and communicating with patients. It is expected that a competent bronchoscopist is able to maneuver the scope through the anatomically complex bronchial tree, take samples, manage the sedated patient and communicate with nursing staff. Learning the complex procedural skills in the clinical setting can be stressful, therefore current bronchoscopic training methodology should blend a number of learning methods including didactic lectures, web-based material, high and low fidelity simulators as well as supervised apprenticeship training. Simulation-based bronchoscopy training therefore has been explored as a mode of training bronchoscopy skills. In this article, the role of simulation-based bronchoscopy training is reviewed. The low fidelity and high fidelity virtual reality bronchoscopy models are described together with the evidence available to support the use of simulation for bronchoscopy training.

Research on the Computer Simulation Training Methods of Taekwondo Athletes before Competitions

In Taekwondo competitions,the competition venues,the on-the-spot environment and the athletes'own tension and other factors have certain effects on the athletes'sports performances.Therefore,through the formulation of the training plans during the competition period,we should ensure the adequate sleep,the reasonable diet,the adequate preparation activities,and the sufficient psychological preparation before the competitions,so that athletes can achieve excellent results.Based on the analysis of the pre-competition computer simulation training methods,this paper puts forward several specific research strategies.

Research on the simulation system of the sports training

In recent years, with the continued progress of science and technology, as an aided tool for physical training, the computer plays a more and more important role in continuously penetrating the high-tech achievements in the sports. The computer simulation technology has been a breakthrough in the training, which has caused the attention of the majority of sports coaches and athletes. According to the analysis of each subject of the sports training, we find that the computer simulation technology has not fully obtained the popularization and application in many aspects of the sports, which is related to the development levels of the computer simulation technology. The simulation system designed in some directions is not practical, and some are still in the blank. Therefore the application of the simulation system in the sports training has a long way to go.

Is There an Improvement in Patient Survival/Code Blue Activation after Training Based on Simulation (Basic Life Support—BLS) Based Practice of Cardiopulmonary Resuscitation?

Background and Aim: The only way to survive a sudden cardiac arrest is when the CPR is performed immediately after the arrest. The focus of the present research study is to assess the effectiveness of a pre- and post-simulation-based BLS training (BLS) and the outcome was measured on the basis of patient survival after the cardiac arrest. Study Design: This pre- and post-training BLS/CPR training study enrolled all nursing staff, all hospital residents, internees, throughout the hospital in a simulation-based BLS training as per the standards of American Heart Association (AHA), to make them respond to immediate resuscitation and code blue activation during the cardiac arrest within the hospital premises including ED, wards, ICUs, MRI, CT and all miscellaneous areas. The providers completed self-efficacy questionnaires as per the AHA protocol before being certified and were evaluated during the emergency in hospital cardiopulmonary arrest. Results: 296 nursing staff, 206 non-healthcare professionals, 143 residents, 212 internees, and 98 medical staff grade doctors completed the BLS training (total 955 hospital staff—providers) were graded for the response by pre- and post-training testing. In the course of pre-BLS training period out of the 250 cardiac arrest patients, 68 patients (27.2%) had ROSC, while after instituting the BLS training period, 143 individuals (40.86%) of the 350 patients who had cardiac arrest had ROSC (p < 0.05). Conclusion: A simulation-based CPR and BLS training curriculum greatly improves patient outcome by reducing mortality and morbidity with improved subjectivity, self-efficiency along with the objective assessment of the performance scores during acute cardiac arrest in Emergency Cardiovascular Care (ECC).

Evaluation of participants' feedback after a simulation-based training in neonatal resuscitation using a realistic delivery room

BACKGROUND: Low-frequency and high-risk situations, such as neonatal resuscitation, are the ideal targets for simulation-based learning. The aim of this paper is to present the structure of our internal neonatal resuscitation training program, using a realistic, simulated delivery room, and to present the participants' opinions about teamwork, emotional stress, and their subjective ability to face a resuscitation. METHODS: We administered a training course to 24 doctors and midwives. One of the simulation classrooms was modified to appear similar to a real delivery room. Four scenarios were conducted using a previously designed checklist of primary and secondary goals. Upon completion, all students participated in a debriefing session with the help of a video review. RESULTS: Students rated the achievement of their previously defined goals on a scale of 1 to 5. Grouping together the percentages of the highest ratings (Categories 4 and 5), 83.4% (20/24) of the students considered the course useful for acquiring clinical skills. For 87.5% (21/24) of the students, the scenarios simulated real clinical situations, the room properly simulated a real delivery room, and the course improved the students' ability to work in a team. For 66.6% (16/24) of the students, the course improved their stress in confronting neonatal resuscitation. Initially, only 33.3% (8/24) of the students considered themselves very capable or fully able to cope with a resuscitation. After the course, that percentage rose to 62.5% (15/24). CONCLUSIONS: The incorporation of simulation-based learning into neonatal resuscitation teaching programs, using realistic scenarios, is useful and offers the possibility of acquiring technical skills, but it also allows for the improvement of teamwork and the adoption of different roles and positive attitudes towards emotional stress.

Development of a simulation model for dynamic derailment analysis of high-speed trains

The running safety of high-speed trains has become a major concern of the current railway research with the rapid development of high-speed railways around the world.The basic safety requirement is to prevent the derailment.The root causes of the dynamic derailment of highspeed trains operating in severe environments are not easy to identify using the field tests or laboratory experiments.Numerical simulation using an advanced train–track interaction model is a highly efficient and low-cost approach to investigate the dynamic derailment behavior and mechanism of high-speed trains.This paper presents a three-dimensional dynamic model of a high-speed train coupled with a ballast track for dynamic derailment analysis.The model considers a train composed of multiple vehicles and the nonlinear inter-vehicle connections.The ballast track model consists of rails,fastenings,sleepers,ballasts,and roadbed,which are modeled by Euler beams,nonlinear spring-damper elements,equivalent ballast bodies,and continuous viscoelastic elements,in which the modal superposition method was used to reduce the order of the partial differential equations of Euler beams.The commonly used derailment safety assessment criteria around the world are embedded in the simulation model.The train–track model was then used to investigate the dynamic derailment responses of a high-speed train passing over a buckled track,in which the derailmentmechanism and train running posture during the dynamic derailment process were analyzed in detail.The effects of train and track modelling on dynamic derailment analysis were also discussed.The numerical results indicate that the train and track modelling options have a significant effect on the dynamic derailment analysis.The inter-vehicle impacts and the track flexibility and nonlinearity should be considered in the dynamic derailment simulations.

Virtual reality simulators for gastrointestinal endoscopy training

The use of simulators as educational tools for medical procedures is spreading rapidly and many efforts have been made for their implementation in gastrointestinal endoscopy training. Endoscopy simulation training has been suggested for ascertaining patient safety while positively influencing the trainees' learning curve. Virtual simulators are the most promising tool among all available types of simulators. These integrated modalities offer a human-like endoscopy experience by combining virtual images of the gastrointestinal tract and haptic realism with using a customized endoscope. From their first steps in the 1980s until today, research involving virtual endoscopic simulators can be divided in two categories: investigation of the impact of virtual simulator training in acquiring endoscopy skills and measuring competence. Emphasis should also be given to the financial impact of their implementation in endoscopy, including the cost of these state-of-theart simulators and the potential economic benefits from their usage. Advances in technology will contribute to the upgrade of existing models and the development of new ones; while further research should be carried out to discover new fields of application.

Numerical simulation and control of welding distortion for double floor structure of high speed train

The welding heat source models and the plastic tension zone sizes of a typical weld joint involved in the double floor structure of high speed train under different welding parameters were calculated by a thermal-elastic-plastic FEM analysis based on SYSWELD code.Then,the welding distortion of floor structure was predicted using a linear elastic FEM and shrinkage method based on Weld Planner software.The effects of welding sequence,clamping configuration and reverse deformation on welding distortion of floor structure were examined numerically.The results indicate that the established elastic FEM model for floor structure is reliable for predicting the distribution of welding distortion in view of the good agreement between the calculated results and the measured distortion for real double floor structure.Compared with the welding sequence,the clamping configuration and the reverse deformation have a significant influence on the welding distortion of floor structure.In the case of30 mm reverse deformation,the maximum deformation can be reduced about 70%in comparison to an actual welding process.