仿真外科训练系统在微创外科的应用

目的 通过比较计算机模拟仿真训练和传统训练模型的训练效果，对模拟仿真训练的有效性和可行性进行评价。方法 17名低年外科医生和24名医学生被随机分成4组，分别受到计算机模拟仿真训练或传统训练模型的训练1h。在接受训练后，他们将在传统训练模型中接受连续缝合测试30min，根据完成缝合的数量和准确性来评价被测试者的能力。结果 无论接受何种训练，低年外科医生的测试结果都优于医学生，尤其在缝合速度方面，无论低年外科医生还是医学生，接受计算机模拟仿真训练的测试结果优于传统训练。结论 计算机模拟仿真训练将可能在腹腔镜外科训练中发挥重要作用。     

Virtual reality bronchoscopy simulation: a revolution in procedural training

BACKGROUND: In the airline industry, training is costly and operator error must be avoided. Therefore, virtual reality (VR) is routinely used to learn manual and technical skills through simulation before pilots assume flight responsibilities. In the field of medicine, manual and technical skills must also be acquired to competently perform invasive procedures such as flexible fiberoptic bronchoscopy (FFB). Until recently, training in FFB and other endoscopic procedures has occurred on the job in real patients. We hypothesized that novice trainees using a VR skill center could rapidly acquire basic skills, and that results would compare favorably with those of senior trainees trained in the conventional manner. METHODS: We prospectively studied five novice bronchoscopists entering a pulmonary and critical care medicine training program. They were taught to perform inspection flexible bronchoscopy using a VR bronchoscopy skill center; dexterity, speed, and accuracy were tested using the skill center and an inanimate airway model before and after 4 h of group instruction and 4 h of individual unsupervised practice. Results were compared to those of a control group of four skilled physicians who had performed at least 200 bronchoscopies during 2 years of training. Student's t tests were used to compare mean scores of study and control groups for the inanimate model and VR bronchoscopy simulator. Before-training and after-training test scores were compared using paired t tests. For comparisons between after-training novice and skilled physician scores, unpaired two-sample t tests were used. RESULTS: Novices significantly improved their dexterity and accuracy in both models. They missed fewer segments after training than before training, and had fewer contacts with the bronchial wall. There was no statistically significant improvement in speed or total time spent not visualizing airway anatomy. After training, novice performance equaled or surpassed that of the skilled physicians. Novices performed more thorough examinations and missed significantly fewer segments in both the inanimate and virtual simulation models. CONCLUSION: A short, focused course of instruction and unsupervised practice using a virtual bronchoscopy simulator enabled novice trainees to attain a level of manual and technical skill at performing diagnostic bronchoscopic inspection similar to those of colleagues with several years of experience. These skills were readily reproducible in a conventional inanimate airway-training model, suggesting they would also be translatable to direct patient care.     

计算机辅助仿真模拟器对心血管专业研究生在冠状动脉造影技能培训中的作用

目的:明确计算机辅助仿真模拟器在心血管专业研究生培养中,是否有助于掌握冠状动脉造影技术。方法:选取我院14名无心血管放射介入经验的在读心血管专业硕士或博士研究生在接受相同课时的冠状动脉介入理论学习后,随机抽取7名研究生接受Angiomentor计算机辅助仿真模拟器培训课程,模拟冠状动脉造影操作;其余7名心血管专业在读硕士研究生未接受仿真模拟器培训,随后在有经验的冠状动脉介入医师指导下于真实临床环境中操作冠状动脉造影,评价操作错误的频数、平均造影时间、造影剂使用量、术中累计放射线剂量及单位面积X线累计曝光剂量。结果:培训组平均操作错误的频数减少50%、平均造影时间减少26·7%、造影剂使用量减少22·2%及术中放射线曝光总剂量明显减少45·7%,单位面积X线累计曝光剂量减少52·1%,少于非培训组。结论:仿真模拟器有助于心血管专业研究生熟练掌握冠状动脉造影技术。     

Augmented reality (AR) and virtual reality (VR) applied in dentistry

The OSCE is a reliable evaluation method to estimate the preclinical examination of dental students. The most ideal assessment for OSCE is used the augmented reality simulator to evaluate. This literature review investigated a recently developed in virtual reality (VR) and augmented reality (AR) starting of the dental history to the progress of the dental skill. As result of the lacking of technology, it needs to depend on other device increasing the success rate and decreasing the risk of the surgery. The development of tracking unit changed the surgical and educational way. Clinical surgery is based on mature education. VR and AR simultaneously affected the skill of the training lesson and navigation system. Widely, the VR and AR not only applied in the dental training lesson and surgery, but also improved all field in our life.     

Mastery learning of advanced cardiac life support skills by internal medicine residents using simulation technology and deliberate practice

BACKGROUND: Internal medicine residents must be competent in advanced cardiac life support (ACLS) for board certification. OBJECTIVE: To use a medical simulator to assess postgraduate year 2 (PGY-2) residents' baseline proficiency in ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards. DESIGN: Pretest-posttest design without control group. After baseline evaluation, residents received 4, 2-hour ACLS education sessions using a medical simulator. Residents were then retested. Residents who did not achieve a research-derived minimum passing score (MPS) on each ACLS problem had more deliberate practice and were retested until the MPS was reached. PARTICIPANTS: Forty-one PGY-2 internal medicine residents in a university-affiliated program. MEASUREMENTS: Observational checklists based on American Heart Association (AHA) guidelines with interrater and internal consistency reliability estimates; deliberate practice time needed for residents to achieve minimum competency standards; demographics; United States Medical Licensing Examination Step 1 and Step 2 scores; and resident ratings of program quality and utility. RESULTS: Performance improved significantly after simulator training. All residents met or exceeded the mastery competency standard. The amount of practice time needed to reach the MPS was a powerful (negative) predictor of posttest performance. The education program was rated highly. CONCLUSIONS: A curriculum featuring deliberate practice dramatically increased the skills of residents in ACLS scenarios. Residents needed different amounts of training time to achieve minimum competency standards. Residents enjoy training, evaluation, and feedback in a simulated clinical environment. This mastery learning program and other competency-based efforts illustrate outcome-based medical education that is now prominent in accreditation reform of residency education.     

The Use of Simulation in Training Graduate Students to Perform Transnasal Endoscopy

A challenge facing the field of speech-language pathology is how to equip students at the university level with the transnasal endoscopy skills needed to perform fiberoptic endoscopic evaluation of swallowing (FEES). The use of simulation has the potential to allow students to gain transnasal endoscopy experience with repetitive practice without compromising patients. The present study examined the effects of two different forms of simulation training on multiple transnasal endoscopic passes on healthy volunteers by graduate student clinicians as measured by procedure duration and confidence ratings. Eighteen speech-language pathology graduate student clinicians were randomly assigned to groups that utilized either a human patient simulator (HPS) or a non-lifelike simulator for transnasal endoscopy training. Using a flexible nasal endoscope, each clinician performed seven training passes on a simulator and one pass on two different volunteers. Each volunteer was endoscoped two times, once by a clinician trained using a HPS and once by a clinician trained using a non-lifelike simulator. There was no difference in pass times on volunteers between clinicians trained using the HPS and clinicians trained on the non-lifelike simulator. Both training groups were faster and more confident on the second endoscopy on a volunteer than on the first.     

Initial airway management skills of senior residents: simulation training compared with traditional training

BACKGROUND: Scenario-based training (SBT) with a computerized patient simulator (CPS) is effective in teaching physicians to manage high-risk, low-frequency events that are typical of critical care medicine. This study compares the initial airway management skills of a group of senior internal medicine residents trained using SBT with CPS during their first year of postgraduate training (PGY) with a group of senior internal medicine residents trained using the traditional experiential method. METHODS: This was a prospective, controlled trial that compared two groups of PGY3 internal medicine residents at an urban teaching hospital. One group (n = 32) received training in initial airway management skills using SBT with CPS in their PGY1 (ie, the simulation-trained [ST] group). The second group (n = 30) received traditional residency training (ie, the traditionally trained [TT] group). Each group was then tested during PGY3 in initial airway management skills using a standardized respiratory arrest scenario. RESULTS: The ST group performed significantly better than the TT group in 8 of the 11 steps of the respiratory arrest scenario. Notable differences were found in the ability to attach a bag-valve mask (BVM) to high-flow oxygen (ST group, 69%; TT group, 17%; p < 0.001), correct insertion of oral airway (ST group, 88%; TT group, 20%; p < 0.001), and achieving an effective BVM seal (ST group, 97%; TT group, 20%; p < 0.001). CONCLUSIONS: Traditional training consisting of 2 years of clinical experience was not sufficient to achieve proficiency in initial airway management skills, mostly due to inadequate equipment usage. This suggests that SBT with CPS is more effective in training medical residents than the traditional experiential method.     

Achieving housestaff competence in emergency airway management using scenario based simulation training: comparison of attending vs housestaff trainers

STUDY OBJECTIVES: To evaluate a teaching protocol comparing a critical care attending to a housestaff team in training medical interns in initial airway management skills using a computer-controlled patient simulator (CPS) and scenario-based simulation training (SST). DESIGN: Prospective, randomized, controlled, unblinded trial. SETTING: Internal medicine residency training program in an urban teaching hospital. PARTICIPANTS: Forty-nine starting internal medicine interns in July 2003, all of whom had been certified in advanced cardiac life support in June 2003. INTERVENTIONS: All interns were tested and scored with a CPS while responding to a standardized respiratory arrest scenario. Random allocation to either training by a single experienced teaching attending or by a housestaff team occurred immediately following testing. All interns were retested using the same scenario 6 weeks following the initial training, and their clinical performance of airway management was scored during actual patient events throughout the year. MEASUREMENTS: Initial airway management was divided into specific scorable steps. For each intern, individual step scores and total scores were recorded before and after training. For 10 consecutive months following training, intern airway management scores were recorded for actual patient airway events. RESULTS: All starting medical interns demonstrated poor initial airway management skills. SST was effective in improving these skills, both on retesting with the patient simulator and in actual patient situations. Interns trained by a housestaff team performed as well as interns trained by the attending. CONCLUSIONS: SST is effective in training medical interns, and the results are equivalent whether the training is provided by an experienced teaching attending or by a housestaff training team.     

The role of virtual reality simulation in surgical training in the light of COVID-19 pandemic: Visual spatial ability as a predictor for improved surgical performance: a randomized trial

Introduction:Due to the current COVID-19 pandemic, surgical training has become increasingly challenging due to required social distancing. Therefore, the use of virtual reality (VR)-simulation could be a helpful tool for imparting surgical skills, especially in minimally invasive environments. Visual spatial ability (VSA) might influence the learning curve for laparoscopic surgical skills. However, little is known about the influence of VSA for surgical novices on VR-simulator training regarding the complexity of different tasks over a long-term training period. Our study evaluated prior VSA and VSA development in surgical trainees during VR-simulator training, and its influence on surgical performance in simulator training.Methods:In our single-center prospective two-arm randomized trial, VSA was measured with a tube figure test before curriculum training. After 1:1 randomization, the training group (TG) participated in the entire curriculum training consisting of 48 different VR-simulator tasks with varying difficulty over a continuous nine-day training session. The control group (CG) performed two of these tasks on day 1 and 9. Correlation and regression analyses were used to assess the influence of VSA on VR-related surgical skills and to measure procedural abilities.Results:Sixty students (33 women) were included. Significant improvements in the TG in surgical performance and faster completion times were observed from days 1 to 9 for the scope orientation 30° right-handed (SOR), and cholecystectomy dissection tasks after the structured 9-day training program. After training, the TG with pre-existing low VSA scores achieved performance levels similar to those with pre-existing high VSA scores for the two VR simulator tasks. Significant correlations between VSA and surgical performance on complex laparoscopic camera navigation SOR tasks were found before training.Conclusions:Our study revealed that that all trainees improved their surgical skills irrespective of previous VSA during structured VR simulator training. An increase in VSA resulted in improvements in surgical performance and training progress, which was more distinct in complex simulator tasks. Further, we demonstrated a positive relationship between VSA and surgical performance of the TG, especially at the beginning of training. Our results identified pre-existing levels of VSA as a predictor of surgical performance.     

Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study

BACKGROUND: Simulation technology is widely used in medical education. Linking educational outcomes achieved in a controlled environment to patient care improvement is a constant challenge. METHODS: This was a retrospective case-control study of cardiac arrest team responses from January to June 2004 at a university-affiliated internal medicine residency program. Medical records of advanced cardiac life support (ACLS) events were reviewed to assess adherence to ACLS response quality indicators based on American Heart Association (AHA) guidelines. All residents received traditional ACLS education. Second-year residents (simulator-trained group) also attended an educational program featuring the deliberate practice of ACLS scenarios using a human patient simulator. Third-year residents (traditionally trained group) were not trained on the simulator. During the study period, both simulator-trained and traditionally trained residents responded to ACLS events. We evaluated the effects of simulation training on the quality of the ACLS care provided. RESULTS: Simulator-trained residents showed significantly higher adherence to AHA standards (mean correct responses, 68%; SD, 20%) vs traditionally trained residents (mean correct responses, 44%; SD, 20%; p = 0.001). The odds ratio for an adherent ACLS response was 7.1 (95% confidence interval, 1.8 to 28.6) for simulator-trained residents compared to traditionally trained residents after controlling for patient age, ventilator, and telemetry status. CONCLUSIONS: A simulation-based educational program significantly improved the quality of care provided by residents during actual ACLS events. There is a growing body of evidence indicating that simulation can be a useful adjunct to traditional methods of procedural training.     

Qualit?tsverbesserung von Koronardiagnostik und -intervention durch ?Virtual-Reality��-Simulation

Currently, more than 800,000 diagnostic procedures and 300,000 percutaneous coronary interventions are performed annually in 556 catheter laboratories in Germany. These numbers document the importance of training programs in interventional cardiology. However, this need is in sharp contrast to the time constraints for continuing medical education in Germany due to personnel and financial restrictions. A possible solution for this dilemma could be new training programs which partially supplement conventional clinical training by simulation-based medical education. Currently five virtual reality simulators for diagnostic procedures and percutaneous coronary interventions are available. These simulators provide a realistic hands-on training comparable to flight simulation in aviation.The simulator of choice for a defined training program depending on the underlying learning objectives could either be a simple mechanical model (for puncture training) or even a combination of virtual reality simulator and a full-scale mannequin (for team training and crisis resource management). For the selection of the adequate training program the basic skills of the trainee, the learning objectives and the underlying curriculum have to be taken into account. Absolutely mandatory for the success of simulation-based training is a dedicated teacher providing feedback and guidance. This teacher should be an experienced interventional cardiologist who knows both the simulator and the selected training cases which serve as a vehicle for transferring knowledge and skills.In this paper the potential of virtual reality simulation in cardiology will be discussed and the conditions which must be fulfilled to achieve quality improvement by simulation-based training will be defined.     

Assessment and learning curve evaluation of endobronchial ultrasound skills following simulation and clinical training

Background and objective: Endobronchial ultrasound is a revolutionary diagnostic pulmonary procedure. The use of a computer endobronchial ultrasound simulator could improve trainee procedural skills before attempting to perform procedures on patients. This study aims to compare endobronchial ultrasound performance following training with simulation versus conventional training using patients. Methods: A prospective study of pulmonary medicine and thoracic surgery trainees. Two cohorts of trainees were evaluated using simulated cases with performance metrics measured by the simulator. Group 1 received endobronchial ultrasound training by performing 15 cases on an endobronchial ultrasound simulator (n = 4). Group 2 received endobronchial ultrasound training by doing 15–25 cases on patients (n = 9). Results: Total procedure time was significantly shorter in group 1 than group 2 (15.15 (±1.34) vs 20.00 (±3.25) min, P < 0.05). The percentage of lymph nodes successfully identified was significantly better in group 1 than group 2 (89.8 (±5.4) vs 68.1 (±5.2), P < 0.05). There was no difference between group 1 and group 2 in the percentage of successful biopsies (100.0 (±0.0) vs 90.4 (±11.5), P = 0.13). The learning curves for simulation trained fellows did not show an obvious plateau after 19 simulated cases. Conclusions: Using an endobronchial ultrasound simulator leads to more rapid acquisition of skill in endobronchial ultrasound compared with conventional training methods, as assessed by an endobronchial ultrasound simulator. Endobronchial ultrasound simulators show promise for training with the advantage of minimizing the burden of procedural learning on patients.     

Efficacy of virtual reality therapy in ideomotor apraxia rehabilitation: A case report

Rationale:We report the possible therapeutic efficacy of immersive virtual reality (VR) rehabilitation for the treatment of ideomotor apraxia in a patient with stroke.Patient concerns:A 56-year-old man with sudden weakness of his left side caused by right frontal, parietal, and corpus callosal infarction was transferred to rehabilitation medicine center for intensive rehabilitation. Although his left-sided weakness had almost subsided 10 days after the onset of symptoms, he presented difficulty using his left hand and required assistance in most activities of daily living.Diagnoses:Ideomotor apraxia in a patient with right hemispheric infarction.Interventions:VR content was displayed to the study participants using a head-mounted display that involved catching of moving fish in the sea by grasping. Before and after of rehabilitative intervention including VR, functional measurements incorporating the Test of Upper Limb Apraxia (TULIA) were conducted. To directly compare therapeutic potencies under different conditions, success rates of consecutive grasping gesture performance were observed in VR, conventional occupational therapy setting, and augmented reality intervention.Outcomes:The patient demonstrated remarkable amelioration of apraxic symptoms while performing the task in the VR environment. At 1 and 3 months after the training, he showed significant improvement in most functions, and the TULIA score increased to 176 from 121 at the initiation of therapy. The number of successful grasps during 30 trials of each grasp trial was 28 in VR, 8 in the occupational therapy setting, and 20 in augmented reality.Lessons:This case report suggests the possible therapeutic efficacy of immersive VR training as a rehabilitative measure for ideomotor apraxia.     

Evaluation of virtual reality bronchoscopy as a learning and assessment tool

BACKGROUND: Conventional training in bronchoscopy involves a trainee performing on a real patient under supervision. This method of training is not only expensive, but there is also potential for increased patient discomfort. Simulators permit the acquisition of necessary technical skills required for the procedure. Virtual reality (VR) has been an integral part of training in aviation, and the application of this technology in medical training needs to be evaluated. OBJECTIVE: This study was conducted to evaluate the efficacy of a VR bronchoscopy simulator as a learning and assessment tool. METHODS: The bronchoscopic simulator (HT Medical Systems, Maryland, USA) is a VR computer programme. The simulator has the ability to assess competence by a set of parameters, which formed the data for the study. Nine novices without previous bronchoscopic experience formed the study group (group 1). Nine experienced bronchoscopists having performed between 200 and 1000 bronchoscopies formed the other group (group 2). We assessed the efficacy of the system as a learning tool by studying whether there was a significant difference between the first and subsequent sessions of the subjects from group 1 and by comparing the performance of the two groups. Statistical analysis was done using the Mann-Whitney U test and the Wilcoxon signed ranks test. RESULTS: There was a significant difference in performance between the first attempt of group 1 and the performance of the experts in terms of percentage of segments visualised and number of wall collisions and the economy of performance. Among the subjects from group 1, there was a significant improvement in percentage of segments visualised by the third attempt (p = 0.04), in the economy of performance by the sixth attempt (0.008) and in the number of wall collisions by the sixth attempt (0.024). When each attempt of the novices was compared with the performance of group 2, the significance in the difference of the percentage of segments studied (p = 0.09) and the economy of performance disappeared by the third attempt (0.06), while the difference in the number of wall collisions disappeared by the fifth attempt (p = 0.06). CONCLUSIONS: This study has been able to establish the face, construct and content validity of the simulator and the potential for it to be an effective training tool.     

Evaluation of clinical competence in cardiovascular disease

The American Board of Internal Medicine has called on directors of cardiology training programs to establish systems to evaluate, document and substantiate those components of overall clinical competence considered essential for certification in the subspecialty. Many of these can be assessed only by repeated direct observations. In particular, proficiency is now required in advanced cardiac life support including cardioversion, electrocardiography (including ambulatory electrocardiographic monitoring) and exercise testing, echocardiography, insertion of arterial lines and right heart catheterization (including insertion of temporary pacemakers). The goal of this expanded evaluation program is to ensure that the public and the profession can identify, through certification, physicians with demonstrated excellence in cardiovascular disease.     

Training and proficiency in endobronchial ultrasound‐guided transbronchial needle aspiration: A systematic review

Endobronchial ultrasound (EBUS)‐guided transbronchial needle aspiration (TBNA) is currently the modality of choice for evaluation of mediastinal lymphadenopathy. However, there is still uncertainty regarding the training methodology and the number of procedures required to attain proficiency in EBUS. Herein, we performed a systematic review of studies selected from PubMed, EmBase and Scopus databases describing the training and assessment of proficiency during EBUS, specifically studies investigating various methods for training, its outcome and the number of procedures required to overcome the learning curve for EBUS. Twenty‐seven (simulator‐based learning (n = 8), tools for assessing competence in EBUS‐TBNA (n = 5) and threshold numbers needed to attain proficiency in EBUS‐TBNA (n = 16)) studies were identified. An EBUS simulator accurately stratified individuals based on the level of experience in performing EBUS. Training received on a simulator was comparable with traditional apprentice‐based training. Importantly, skills acquired on a simulator could be transferred to real‐world patients. The number needed to overcome the initial learning curve of EBUS varied from 10 to 100 in individual studies with a mean of 37–44 procedures. Tools such as EBUS‐STAT (EBUS skill and task assessment tool) and EBUSAT (EBUS skill and assessment tool) were effective in evaluating the EBUS trainees. We conclude that an EBUS simulator or EBUS assessment tools can objectively assess the training of an EBUS trainee. Simulator‐based training is a useful modality in EBUS training. The number of procedures needed to overcome the initial learning curve is about 40. Centres involved in EBUS training could incorporate simulator‐based training in their curriculum before allowing operators to perform EBUS on patients.     

Turning virtual reality into reality: a checklist to ensure virtual reality studies of eating behavior and physical activity parallel the real world

Virtual reality (VR) provides a potentially powerful tool for researchers seeking to investigate eating and physical activity. Some unique conditions are necessary to ensure that the psychological processes that influence real eating behavior also influence behavior in VR environments. Accounting for these conditions is critical if VR-assisted research is to accurately reflect real-world situations. The current work discusses key considerations VR researchers must take into account to ensure similar psychological functioning in virtual and actual reality and does so by focusing on the process of spontaneous mental simulation. Spontaneous mental simulation is prevalent under real-world conditions but may be absent under VR conditions, potentially leading to differences in judgment and behavior between virtual and actual reality. For simulation to occur, the virtual environment must be perceived as being available for action. A useful chart is supplied as a reference to help researchers to investigate eating and physical activity more effectively.     

Training older adults with virtual reality use to improve collision-avoidance behavior when walking through an aperture

Many older adults perform collision-avoidance behavior either insufficiently (i.e., frequent collision) or inefficiently (i.e., exaggerated behavior to ensure collision-avoidance). The present study examined whether a training system using virtual reality (VR) simulation enhanced older adults’ collision-avoidance behavior in response to a VR image of an aperture during real walking. Twenty-five (n = 13 intervention group and n = 12 control group) older individuals participated. During training, a VR image of walking through an aperture was projected onto a large screen. Participants in the intervention group tried to avoid virtual collision with the minimum body rotation required to walk on the spot through a variety of narrow apertures. Participants in the control group remained without body rotation while walking on the spot through a wide aperture. A comparison between pre-test and post-test performances in the real environment indicated that after the training, significantly smaller body rotation angles were observed in the intervention group. This suggests that the training led participants to modify their behavior to try to move efficiently during real walking. However, although not significant, collision rates also tended to be greater, suggesting that, at least for some participants, the modification required to avoid collision was too difficult. Transfer of the learned behavior using the VR environment to real walking is discussed.     

As accessible as a book on a library shelf: the imperative of routine simulation in modern health care

Technology-enhanced patient simulation has emerged as an important new modality for teaching and learning in medicine. In particular, immersive simulation platforms that replicate the clinical environment promise to revolutionize medical education by enabling an enhanced level of safety, standardization, and efficiency across health-care training. Such an experiential approach seems unique in reliably catalyzing a level of emotional engagement that fosters immediate and indelible learning and allows for increasingly reliable levels of performance evaluation-all in a completely risk-free environment. As such, medical simulation is poised to emerge as a critical component of training and certification throughout health care, promising to fundamentally enhance quality and safety across disciplines. To encourage routine simulation-based practice as part of its core quality and safety mission, Massachusetts General Hospital now incorporates simulation resources within its historic medical library (est. 1847), located at the center of the campus. In this new model, learners go to the library not only to read about a patient's illness, but also to take care of their "patient." Such an approach redefines and advances the central role of the library on the campus and ensures that simulation-based practice is centrally available as part of everyday hospital operations. This article describes the reasons for identifying simulation as an institutional priority leading up to the Massachusetts General Hospital Bicentennial Celebration (1811-2011) and for creating a simulation-based learning laboratory within a hospital library.     

SCAI/SVM expert consensus statement on Carotid Stenting: Training and credentialing for Carotid Stenting

Carotid artery stenting (CAS) has become an integral part of the therapeutic armamentarium offered by cardiovascular medicine programs for the prevention of stroke. The purpose of this expert consensus statement is to provide physician training and credentialing guidance to facilitate the safe and effective incorporation of CAS into clinical practice within these programs. Since publication of the 2005 Clinical Competence Statement on Carotid Stenting, there has been substantial device innovation, publication of numerous clinical trials and observational studies, accumulation of extensive real‐world clinical experience and widespread participation in robust national quality improvement initiatives [5]. Collectively, these advances have led to substantial evolution in the selection of appropriate patients, as well as in the cognitive, technical and clinical skills required to perform safe and effective CAS. Herein, we summarize published guidelines, describe training pathways, outline elements of competency, offer strategies for tracking outcomes, specify facility, equipment and personnel requirements, and propose criteria for maintenance of CAS competency. © 2015 Wiley Periodicals, Inc.