Medical Training

Computer games are an increasingly popular application for Artificial Intelligence (AI) research, and conversely AI is an increasingly popular selling point for commercial games. Although games are typically associated with entertainment, there are many "serious" applications of gaming, including military, corporate, and advertising applications. There are also so-called "humane" gaming applications for medical training, educational games, and games that reflect social consciousness or advocate for a cause. Game AI is the effort of going beyond scripted interactions, however complex, into the arena of truly interactive systems that are responsive, adaptive, and intelligent. Such systems learn about the player(s) during game play, adapt their own behaviors beyond the pre-programmed set provided by the game author, and interactively develop and provide a richer experience to the player(s). The long-term goal of our research is to develop artificial intelligence techniques that can have a significant impact in the game industry. In this paper, we present a list of challenges and research opportunities in developing techniques that can be used by computer game developers. We discuss three Case-Based Reasoning (CBR) (Aamodt & Plaza 1994), (Kolodner 1993) approaches to achieve adaptability in games: automatic behavior adaptation for believable characters; drama management and user modeling for interactive stories; and strategic behavior planning for real-time strategy games.

Drosophila melanogaster is a small fruit fly that feeds on and lives around spoiled fruit. It is one of the most valuable organisms in genetics research and developmental biology. Drosophila's are popularly used in studying traits because they are practical, small and have a short life cycle of about two weeks (Manning et al, 2006). We are demonstrating exactly how Drosophila melanogaster are used to identify mechanisms of transmission genetics in eukaryotes. F1 and F2 generations were obtained by performing simple parental crosses. This was done so we could determine the mode of inheritance of the genetic trait of eye color. The mode of inheritance was different for all of the crosses but all deal with Mendel's principles. Our results from the chi square analysis data all showed signs of our observed dating matching almost exactly to our expected data. We were able to accept our null hypothesis for all crosses.

The development of immersive learning technologies in the form of virtual reality and advanced computer applications has meant that realistic creations of simulated environments are now possible. Such simulations have been used to great effect in training in the military, air force, and in medical training. But how realistic do problems need to be in education for effective learning to occur? Some authors and researchers argue that problems should be real, or that simulations should have ultra-realistic physical similarity to an actual context. This paper proposes that physical verisimilitude to real situations is of less importance in learning than 'cognitive realism', provided by immersing students in engaging and complex tasks. The paper presents a description of the theory and research that provide the foundations for this approach. Examples of courses employing cognitive, rather than physical, realism are presented together with the views of teachers, authors and instructional designers. Finally, the implications of this approach are discussed.

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The simulation of medical procedures through virtual reality systems can offer realistic training environments for new professionals. This paper presents the development of a simulator for medical training, based in a previous study case. The application was completely developed using a free system called CyberMed which provides high-level access to several functionalities expected in a virtual reality simulator. Details of the application development will be presented. The results obtained will be compared with the previous case study.

rule systems can affect reasoning about everyday-life eventsnhas been rejected by 20th century psychologists on the basis of rather scant evidence. We examined the effects of graduate training in law, medicine, psychology, and chemistry on statistical reasoning, methodological reasoning about confounded variables, and reasoning about problems in the logic of the conditional Both psychology and medical training produced large effects on statistical and methodological reasoning, and psychology, medical, and law training produced effects on ability to reason about problems in the logic of the conditional Chemistry training had no effect on any type of reasoning studied. These results seem well understood in terms of the rule systems taught by the various fields and indicate that a version of the formal discipline hypothesis is correct. The 20th Century Critique of Formal Discipline Although there were objections to the standard curriculum as early as the Enlightenment on the grounds that the rules of mathematics and Latin bear little actual resemblance to the rules necessary to think about most everyday-life events, it was not until the late 19th century that the view came under concerted attack 9 The attack came from psychologists, and it was utterly effective. In fact, it was one of the first policy victories of the new field. William James was withering in his critique of "faculty psychology," that is, of the view that mental abilities consisted of faculties such as memory, reasoning, and will that could be improved by mere exercise in the way that muscles could 9 Thorndike (1906, 1913) undertook a program of research, still impressive by modern standards, that showed little transfer of training across tasks, for example, from canceling letters to canceling parts of speech or from estimating areas of rectangles of one size and shape to estimating areas of rectangles of another size

Although many psychologists support prescription privileges, the historical training paradigm in psychology includes limited scientific education directly relevant to prescribing medications. Issues related to prescriptive authority for psychologists, including training gaps, attitudes, accreditation, and regulation, are discussed. Current proposals for training psychologists to prescribe deleted the prerequisite coursework in the biological and physical sciences that had been identified by the American Psychological Association's Ad Hoc Task Force on Psychopharmacology. Current proposals do not delineate clear requirements for several key aspects of supervised practical training. Such training limitations raise basic questions about how much additional scientific and medical training would be necessary to ensure that psychologists could provide an acceptable quality of clinical pharmacologic care.

Increasing access through innovative admission criteria From the very beginning, an affirmative action plan was implemented in the medical training program aimed at increasing the number of black African students, especially from the Transkei region, and at achieving a student population whose racial profile would mirror that of the South African population (70% black African; 20% white; 10% Asian and mixed races). In traditional South African medical schools, admission was based purely on aca

As educators seek confirmation of successful trainee achievement, medical education must move toward a more evidence-based approach to teaching and evaluation. Although medical training often provides physicians with a general background in biostatistics, many are not prepared to apply these skills. This can hinder clinician educators as they wish to develop, analyze and disseminate their scholarly work. This paper is intended to be a concise educational tool and guide for choosing and interpreting statistical tests aimed toward medical education assessment. It includes guidelines and examples that clinicianeducators can use when analyzing and interpreting studies and when writing methods and results sections of reports.

In healthcare, developing high procedural skill levels through training is a key factor for obtaining good clinical results on surgical procedures. Providing feedback to each student tailored to how the student has performed the procedure each time, improves the effectiveness of the training. Current state-of-the-art feedback relies on Checklists and Global Rating Scales to indicate whether all process steps have been performed and the quality of each execution step. However, there is a process perspective not successfully captured by those instruments, e.g., steps performed but in an undesired order, part of the process repeated an unnecessary number of times, or excessive transition time between steps. In this work, we propose a novel use of process mining techniques to effectively identify desired and undesired process patterns regarding rework, order, and performance, in order to complement the tailored feedback of surgical procedures using a process perspective. The approach has been effectively applied to analyze a real Central Venous Catheter installation training case. In the future, it is necessary to measure the actual impact of feedback on learning.

This review paper discusses the role of haptics within virtual medical training applications, particularly, where it can be used to aid a practitioner to learn and practice a task. The review summarizes aspects to be considered in the deployment of haptics technologies in medical training. First, both force/torque and tactile feedback hardware solutions that are currently produced commercially and in academia are reviewed, followed by the available haptics-related software and then an in-depth analysis of medical training simulations that include haptic feedback. The review is summarized with scrutiny of emerging technologies and discusses future directions in the field.

The current economic crisis in Africa has posed a serious challenge to policies of comprehensive and equitable health care. This paper examines the extent to which the Zimbabwe government has achieved the policy of "Equity in Health" it adopted at independence in 1980, that is provision of health care according to need. The paper identifies groups with the highest level of health needs in terms of both health status and economic factors which increase the risk of ill health. It describes a series of changes within the health sector in support of resource redistribution towards health needs, including a shift in the budget allocation towards preventive care, expansion of rural infrastructures, increased coverage of primary health care, introduction of free health services for those earning below Z$lSO a month in 1980, increased manpower deployment in the public sector and the reorientation of medical training towards the health needs of the majority. The implementation of equity policies in health have however been challenged by several trends and features of the health care system, these becoming more pronounced in the economic stagnation period after 1983. These include the reduction in allocations to local authorities, increasing the pressure for fees, the static nominal level of the free health care limit despite inflation, the continued concentration of financial, higher cost manpower and other resources within urban, central and private sector health care and the lack of effective functioning of the referral system, with high cost central quatemary facilities being used as primary or secondary level care by nearby urban residents. While primary health care expansion has clearly been one of the success stories of Zimbabwe's health care post 1980, the paper notes plateauing coverage, with evidence of lack of coverage in more high risk, socio-economically marginal communities. Measures to address these continuing inequalities are discussed. Their implementation is seen to be dependent on increasing the capacity and organisation of the poor to more strongly influence policy and resource distribution in the health sector.

The practice of medicine has always been characterized by uncertainty. Yet, attempts to study tolerance for uncertainty in medicine have been few, and limited to its influence on specialty preferences and test-ordering behavior. In particular, studies have not investigated how the process of socialization into the medical profession affects tolerance for uncertainty.

In 1994 and 1995, the Medical Council of Canada used an innovative approach to set the pass mark on its large scale, multi-center national OSCE which is designed to assess basic clinical and communication skills in physicians in Canada after 15 months of post-graduate medical training. The goal of this article is to describe the new approach and to present the experience with the method during its first two years of operation. The approach utilizes the global judgments of the physician examiners at each station to identify the candidates with borderline performances. The scores of the candidates whose performances are judged to be borderline are summed for each station, yielding an initial passing score for all stations and then the examination as a whole. The latter score is then adjusted upward one standard error of measurement for the final passing score and is used as one of the criteria to pass the examination. Based on the results to date, the new approach has worked well. The...

Background: In recent years outpatient palliative care, even for patients in an advanced state of their disease, has gained importance. Therefore, also paramedics are more often confronted with palliative emergencies, advance directives, and ethical end-of-life issues. Presently in emergency medicine there is undoubtedly a lack of education on palliative medicine and ethical questions for paramedics.

In this paper, a patient model is used in the core of a medical training simulator. A concrete case is developed and validated by an expert. The process followed in description, designing and evaluation of this case is described in detail. In addition, a windows based application is developed using visual C++ in order to assist during this designing process.

The work in the Touch Lab (formal name: Laboratory for Human and Machine Haptics) is guided by a broad vision of haptics which includes all aspects of information acquisition and object manipulation through touch by humans, machines, of a combination of the two; and the environments can be real or virtual. In order to make progress, we conduct research in multiple disciplines such as skin biomechanics, tactile neuroscience, human haptic perception, robot design and control, mathematical modeling and simulation, and software engineering for real-time human-computer interactions. These scientific and technological research areas converge in the context of specific application areas such as the development of virtual reality based simulators for training surgeons, real-time haptic interactions between people across the Internet, and direct control of machines from brain neural signals.

There is increasing realization that some tasks can be performed significantly better by humans than robots but, due to associated hazards, distance, etc., only a robot can be employed. Telemedicine is one area where remotely controlled robots can have a major impact by providing urgent care at remote sites. In recent years, remotely controlled robotics has been greatly advanced and the NASA Johnson Space Center's robotic astronaut, "Robonaut," is one such example. Unfortunately, due to the unavailability of force and tactile feedback the operator must determine the required action by visually examining the remote site and therefore limiting the tasks that Robonaut can perform. There is a great need for dexterous, fast, accurate teleoperated robots with the operator's ability to "feel" the environment at the robot's field. The authors conceived a haptic mechanism called MEMICA (Remote MEchanical MIrroring using Controlled stiffness and Actuators) that can enable the design of high dexterity, rapid response, and large workspace haptic system. The development of a novel MEMICA gloves and virtual reality models are being explored to allow simulation of telesurgery and other applications. The MEMICA gloves are being designed to provide intuitive mirroring of the conditions at a virtual site where a robot simulates the presence of a human operator. The key components of MEMICA are miniature electrically controlled stiffness (ECS) elements and Electrically Controlled Force and Stiffness (ECFS) actuators that are based on the use of Electro-Rheological Fluids (ERF). In this paper the design of the MEMICA system and initial experimental results are presented.

Making decisions about the care of individual patients is fundamental to health care. For each patient, many decisions have to be made. In the emergency room, for example, a doctor should decide which patient to see first, decide whether an x-ray should be made of an injured ankle, and decide how this specific ankle fracture of this specific patient should be treated. Medical training is focused on acquiring the knowledge and experience to make such decisions. Other factors that are essential for patient care, including empathy and technical abilities, also involve decision making. For example, in the outpatient clinic, a trade-off is needed when one patient needs more time and empathy, but the waiting room is packed and the physician is an hour behind schedule. In the operating room, a surgeon must decide whether to proceed with a complicated laparoscopic procedure to remove a gall bladder, to convert to an open procedure, or to ask a more experienced surgeon for help.

Introduction: To evaluate the perceptions of the graduates of our medical school regarding the quality of their educational programme. Materials and Methods: A total of 183 questionnaires, each containing 262 questions, were completed anonymously by medical students upon their graduation from the medical school. Results: About 77% of the respondents felt that Basic Science courses lacked clinical relevance. Many of the students (61.2%) believed that physiology, amongst other Basic Science courses, was the most clinically relevant course. Assessment of the students about their clinical clerkship and internship rotations was not very favourable. Overall only 28.4% of the respondents were generally satisfied with the medical training they received. Respondents indicated many deficiencies in the curriculum, and in their competences. Exposure to numerous activities was rated by respondents as being inadequate: "geriatrics and gerontology education" (87.5%), "office management" (86.4%), "alternative medicine" (85.8%), "healthcare quality improvement" (85.7%), and "rehabilitation" (83%). Around 70% of the respondents reported that they have not been taught sufficient clinical skills in preparations for their future clinical practice. Only 33.3% of the respondents felt that they had acquired adequate knowledge and skills to start residency training. Conclusions: This study illuminates many aspects of the curriculum the faculty needs to address in order to prepare physicians effectively and efficiently for clinical work. It can be used as a tool to find the trends in our curriculum and the impact of curriculum revision activities which are currently underway in our School of Medicine.

Object Nowadays, most of the surgical training programs follow a duration-based format that focuses on improving technical skills of trainees for a fixed amount of time before declaring their proficiency. More recently, different approaches have been proposed for the skills assessment; such as the objective structured clinical examination (OSCE). The OSCE consists of different stations in which trainees are required to perform practical exams while their performance is evaluated by examiners. However, their performance cannot be easily assessed by the simple observation of the task. As a result, no standard evaluation criteria can be conceived. Methods Thanks to the recent advances in Robot Technology (RT); more efficient training systems can be conceived. In particular, authors believe in the importance of developing automated training devices designed to provide training progress quantitative information of trainees. For this reason, at Waseda University, since 2004, we have proposed as a long-term research goal, the development of a Patient Robot which nearly reproduces the human body anatomy and physiology by embedding sensors and actuators into a human model. Due to the complexity of patient robot development, as a first approach, we have proposed the development of a Suture/Ligature Training System. In this paper, the details of Waseda-Kyotokagaku Suture No. 2 Refined II (WKS-2RII) are presented. The WKS-2RII has been designed to reproduce the task conditions of the suture and ligature as well as to provide quantitative information of artificial skin movement, and the physical properties of the suture. From such collected data, we have proposed an Evaluation Function that integrates all the proposed evaluation parameters. Results In order to verify the effectiveness of the WKS-2RII, a set of experiments were proposed to analyze the performance of subjects while performing the task with the WKS-2RII. The experiments were designed to determine if the proposed system may provide more detailed information of the task in a quantitative way. From the experimental results, we have confirmed that the WKS-2RII is capable of providing quantitative assessment of the task. In contrast to the conventional training methods (i.e., OSCE, etc.), the WKS-2RII can provide more detailed information of the task performance, so that the proposed system can detect the differences among different level of expertise (five surgeons, five medical students and five unskilled persons) as well as detect improvements of trainees by plotting the learning curve. Conclusions In this paper, we have presented the improvements on the WKS-2RII and a unique evaluation function has been proposed. Regarding the weighting coefficients, the discriminant analysis method was used to determine the optimal values of the weighting coefficients.

This is a review of recently published literature on surgery in tropical Africa. It presents the current state of surgical need and surgical practice on the continent. We discuss the enormous burden of surgical pathology (as far as it is known) and the access to and acceptability of surgery. We also describe the available facilities in terms of equipment and manpower. The study looked at the effects of the human immunodeficiency virus, the role of traditional healers, anesthesia, and the economics of surgery. Medical training and research are discussed, as are medical migration out of Africa and the concept of task shifting, where surgical procedures are performed by others when surgeons are not available. It closes with recommendations for involvement and action in this area of great global need.

BACKGROUND: Medical students are rarely taught how to integrate communication and clinical reasoning. Not understanding the relation between these skills may lead students to undervalue the connection between psychosocial and biomedical aspects of patient care.

This article deals with the presence of physicians, surgeons and  apothecaries in the early modern Portuguese empire and the dissemination of medical knowledge there. In Portugal itself, the health care sector had been the target of considerable royal interference since the final years of the fifteenth century, during the construction of the early modern state. Regulatory frameworks were established to harmonise health care practice throughout the country and to control the organisation and distribution of the available health care
practitioners among local communities. As this was also the time when Portugal was investing heavily in its colonies, how were these policies reflected in the empire? Did health care feature in the Portuguese
government’s colonial strategies? How did the official policy to send medical personnel overseas work on the ground? Did it operate at a large enough scale to transform local practices?

Context and objectives: Undergraduate medical training program accreditation is practiced in many countries, but information from developing countries is sparse. We compared medical training program accreditation systems in nine developing countries, and compared these with accreditation practices in the United States of America (USA). Methods: Medical program accreditation practices in nine developing countries were systematically analyzed using all available published documents. Findings were compared to USA accreditation practices. Findings: Accreditation systems with explicitly defined criteria, standards and procedures exist in all nine countries studied:

This article contributes to knowledge on medical training and careers at a time of change driven by Enlightenment ideas, but also a time of conflict between age-old structures and new legal frameworks. By analyzing an individual trajectory in interaction with other individuals and institutions, the contradictions of the historical context that constrained the life of José Pinto de Azeredo are brought to light. The circumstances surrounding his professional activity are analyzed an aspect of this physician's trajectory that was until now unstudied. Some hypotheses are formulated to explain why he did not reach the objectives he set for himself.

This article reports a study comparing the problem-solving performance of housestaff with undergraduate medical training in either conventional or problem-based schools. After reading two clinical cases, residents were required to write differential diagnoses and pathophysiological explanations. Biomedical and clinical knowledge used and reasoning strategies were identified. The results suggest that housestaff performance is influenced by the nature of instruction. Housestaff trained in a conventional curriculum (CC) focused on patient information, separated biomedical from clinical knowledge, and used data-driven strategies. Housestaff from problem-based learning curricula (PBLC) organized their knowledge around generated inferences, integrated biomedical and clinical knowledge, and used hypothesis-driven strategies. Data-driven reasoning appears to be impeded in PBLC, suggesting that PBLC students have difficulties in acquiring problem schemata. Previous investigations also found ...

Summary. Concern is often expressed about the English language proficiency (ELP) of students engaged in professional training. This report assesses the ELP of the 1990 and 1991 intakes into medicine at the University of Sydney. A quick screening test and individual in-depth tests were used in a two-stage design. Admission to the course is highly competitive and most students are selected from the top 0.75% of Higher School Certificate results but 15% and 19% of the year cohorts were found to be below average in ELP. English proficiency was found to be consistently correlated with first- and second-year university results. Initiatives taken to support students with language disadvantages and to ensure that graduates will be able to communicate effectively with patients are outlined.

When prescribing opioids to treat chronic pain, physicians face the dilemma of balancing effective pain management while avoiding iatrogenic opioid addiction. Through mailed surveys, the current study assessed concerns, perceptions, and practices of primary care physicians related to this dilemma. Of the 35 (43%) physicians that replied, 32 (91.4%) reported to prescribe opioids for pain. Twenty-six (81.3%) physicians mentioned that "legitimate pain" was the main reason why most patients who are opioid dependent begin using opioids. Most physicians (71.5%) rated their knowledge/comfort of treatment/management of opioid dependence as being low. Although these physicians believed training is essential to learning about the risks involved with chronic pain and opioid dependence, many of these physicians evaluated their own medical training in these areas as unsatisfactory. Training programs may better equip primary care physicians when addressing the treatment of chronic pain and addiction to opioids.

Little sociological research has sought to investigate the ways in which women with hospitalized newborn infants construct and practice motherhood. This article seeks to address this lacuna, using data from a qualitative research project based in two Australian neonatal nurseries. Thirty-one mothers of hospitalized newborns and 20 neonatal nurses were interviewed, and other data were obtained via observations of the nurseries, tape-recorded verbal interactions between parents and nursery staff and casual conversations with mothers and nurses. The data revealed that while the mothers' and nurses' discourses on what makes a 'good mother' in the context of the neonatal nursery converged to some extent, there were important differences. The mothers particularly emphasized the importance of physical contact with their infants and breastfeeding, while the nurses privileged presence in the nursery and willingness to learn about the infant's condition and treatment. There was evidence of power struggles between the mothers and nurses over the handling and treatment of the infants, which had implications for how the mothers constructed and practised motherhood. The mothers attempted to construct themselves as 'real mothers', which involved establishing connection with their infants and normalizing them. In time, many of the mothers sought to position themselves as the 'experts' on their infants. For their part, the nurses attempted to position themselves as 'teachers and monitors of the parents', 'protectors of the infants' and 'experts' by virtue of their medical training and experience. Differences in defining the situation resulted in frustration, resentment and anger on the part of the mothers and disciplinary and surveillance actions on the part of many of the nurses, both covert and overt. The nurses' attitude to and treatment of the mothers was integral in the development of the mothers' relationship with their infants in the nurseries, and this influence extended beyond discharge of the infants.

In anatomy education, assessment may be done by written, practical or oral methods. These are used to varying degrees in UK medical schools with no consensus on the preferred approach. The purpose of this article is to highlight changes to methods of anatomical knowledge assessment utilised in medical schools since the early 1990s and to present recommended methods of assessment according to the level of medical training. Methods Medical students, trainees and specialists in the London (UK) area were surveyed to: (1) identify methods experienced in anatomy education at medical school and (2) gather recommendations. Medical student, trainee and specialist responses were compared using non-parametric tests. Results Two hundred and twenty-eight individuals responded to the survey giving a response rate of 53%. Subjects who graduated before 2005 were assessed signiWcantly more frequently by practical (94.2 vs. 33.3%) and oral (84.5 vs. 13.1%) methods than those whose graduation year was 2005 or later. Subjects whose graduation year was 2005 or later were assessed signiWcantly more frequently by written methods, such as EMQs than those whose graduation was before 2005 (68.7 vs. 25.2%). Practical examination was identiWed as the most recommended method of assessment in anatomy education by medical students (59.1%), trainees (all stages combined; 54.2%) and specialists (51.7%). Conclusion Practical assessment is recommended over written and oral methods for the assessment of anatomical knowledge. A formal evaluation of the relative beneWts and limitations of available assessment tools is required.

The paper addresses the opportunity of using gestures in virtual environments by taking into account current technologies for capturing human gestures, existing interaction techniques and various aspects dealing with gesture and gesticulation functionalities. Virtual environments have proven to be of an effective usefulness for a variety of applications such as medical training and exploration, military simulations, architecture, phobia therapy, etc. A great variety of devices have been developed for effectively interacting with such environments and many interaction techniques have been introduced. Many of them prove to be cumbersome and more or less obstructing the user and hence affecting his/her virtual experience. Natural gestures as a mean of human computer interaction have the great advantage of being the ideal interface as natural, efficient and intuitive means of communication (people use gestures everyday in a natural manner). Discussion is equally conducted on gestures being used for the three main tasks commonly encountered in virtual environments: selection, manipulation and travel. References to gesture definition and classification according to different criteria and their relevance for interacting in virtual environments are equally taken into account.