Military medicine
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A medical records review to compare efficiency and effectiveness of a physical therapist (PT) functioning as a musculoskeletal primary care provider (PCP) compared to family practice (FP) physicians functioning as musculoskeletal PCP. ⋯ Using PT as the musculoskeletal PCP was shown to be an effective and efficient practice model to assess and treat patients with musculoskeletal complaints.
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Observational Study
Prevalence of prehospital hypoxemia and oxygen use in trauma patients.
This study estimates the prevalence of injured patients requiring prehospital supplemental oxygen based on existing recommendations, and determines whether actual use exceeds those recommendations. ⋯ On the basis of current guidelines, less than half of adult trauma patients have an indication for prehospital supplemental oxygen, yet is frequently administered in the absence of clinical indication.
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Randomized Controlled Trial
Effects of simulation-based practice on focused assessment with sonography for trauma (FAST) window identification, acquisition, and diagnosis.
We compared the effects of simulator-based virtual ultrasound scanning practice with classroom-based ultrasound scanning practice on participants' knowledge of focused assessment with sonography for trauma (FAST) window quadrants and interpretation, and on participants' performance on live patient FAST examinations. Novices with little or no ultrasound training experience received simulation-based practice (n = 24) or classroom-based practice (n = 24). Participants who received simulation-based practice scored significantly higher on interpreting static images of FAST windows. ⋯ Overall, classroom-based practice appeared to promote physical acquisition skills and simulator-based practice appeared to promote window interpretation skills. Accurate window interpretation is critical to identification of blunt abdominal trauma injuries. The simulator used (SonoSimulator) appears promising as a training tool to increase probe time and to increase exposure to FAST windows reflecting various anatomy and disease states.
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Recent advances in the learning sciences offer remarkable potential to improve medical education and maximize the benefits of emerging medical technologies. This article describes 2 major innovation areas in the learning sciences that apply to simulation and other aspects of medical learning: Perceptual learning (PL) and adaptive learning technologies. PL technology offers, for the first time, systematic, computer-based methods for teaching pattern recognition, structural intuition, transfer, and fluency. ⋯ The author describes the Adaptive Response-Time-based Sequencing (ARTS) system, which uses each learner's accuracy and speed in interactive learning to guide spacing, sequencing, and mastery. In recent efforts, these new technologies have been applied in medical learning contexts, including adaptive learning modules for initial medical diagnosis and perceptual/adaptive learning modules (PALMs) in dermatology, histology, and radiology. Results of all these efforts indicate the remarkable potential of perceptual and adaptive learning technologies, individually and in combination, to improve learning in a variety of medical domains.
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Pressures to increase the efficacy and effectiveness of medical training are causing the Department of Defense to investigate the use of simulation technologies. This article describes a comprehensive cognitive task analysis technique that can be used to simultaneously generate training requirements, performance metrics, scenario requirements, and simulator/simulation requirements for medical tasks. On the basis of a variety of existing techniques, we developed a scenario-based approach that asks experts to perform the targeted task multiple times, with each pass probing a different dimension of the training development process. ⋯ The technique was pilot tested with expert instructors from a large military medical training command. These instructors were employed to generate requirements for two selected combat casualty care tasks-cricothyroidotomy and hemorrhage control. Results indicated that the technique is feasible to use and generates usable data to inform simulation-based training system design.