Identifying and Reducing Errors with Surgical Simulation

通过手术模拟识别和减少错误

• 批准号: 6528340
• 负责人: marvin p fried
• 金额: $ 40.59万
• 依托单位: MONTEFIORE MEDICAL CENTER (BRONX, NY)
• 依托单位国家: 美国
• 财政年份: 2001
• 资助国家: 美国
• 起止时间: 2001-09-27 至 2004-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6528340
• 关键词: clinical research; computer simulation; endoscopy; health service demonstration project; human subject; medical education; otorhinolaryngologic surgery; physicians

The training of a surgeon requires the acquisition of a number of characteristics. These include a knowledge base (cognitive), problem formulation, decision processing, psychosocial relationships and others that can be evaluated and graded by objective testing such as National Board or Specialty Certifying examinations. Critical to the surgeon are the technical skills that are at the core of the profession. This proposal responds to the need to create a battery of sophisticated devices and objective measurements to teach and evaluate the inherent technical ability of trainees. We hypothesize that by innovative, state- of-the-art simulation, devices that train both surgical tasks and skills through repetitive proctored challenges, without risk to patients, will allow for detection and analysis of surgical errors and "near misses". In an analogy to flight simulation, "near miss" detection is where potential errors are found and complications prevented Using a number of otolaryngology residencies, a controlled training curriculum will be developed based on complimentary simulation tools [the endoscopic sinus surgery simulator (ES3), minimally invasive surgical trainer - virtual reality (MIST VR), perceptual and 3- dimensional testing] with objective metrics used for assessment of trainees. Technical errors will be identified, quantified and used to train and monitor surgical performance and for outcomes analysis to improve patient safety. Some current validated metrics include: time- to-completion, errors, economy of motion and psychomotor tracking. Correlation with psychometric parameters (perception, psychomotor, visio-spatial, cognitive mapping, etc.) will be used to identify technical errors and to validate both the simulator and the curriculum. The collaborating investigators and institutions have expertise in the areas of metrics, curriculum, database development, simulator creation and modification, and outcomes analysis. Endoscopic sinus surgery is the operation substrate since it is frequently performed (greater than 300,000 procedures annually) and carries a significant risk of injury to the contiguous structures ofthe eye (loss of vision and /or eye motion) and brain (CSF leakage, meningitis, death). The ES3 is also the most advanced surgical simulation device existing and based largely on jet pilot flight simulation (Lockheed Martin).

外科医生的训练需要获得许多特征。这些包括知识库（认知），问题制定，决策处理，社会心理关系以及其他可以通过客观测试（例如国家董事会或专业认证考试）进行评估和评分的其他知识基础。对外科医生至关重要的是专业核心的技术技能。该建议响应创建一系列复杂设备和客观测量的需求，以教学和评估受训者的固有技术能力。我们假设，通过创新的状态模拟，通过重复的监管挑战训练手术任务和技能的设备，没有患者的风险，将允许对手术错误和“接近失误”进行检测和分析。在与飞行模拟的类比中，“接近错过”的检测是发现潜在的错误和使用多个耳鼻喉科驻留的潜在错误和预防的并发症，将基于免费的模拟工具[内镜窦手术模拟器（ES3），最小的传统训练师 - virtial Metife and Motetrion和3--虚拟现实（off），off），off cor and off），将开发一项受控的培训课程，以下用于评估受训者。技术错误将被识别，量化和用于训练和监测外科手术性能以及以提高患者安全性的结果分析。当前有验证的指标包括：时间到完成，错误，运动经济和心理运动跟踪。将使用与心理测量参数（感知，心理动物，粘膜空间，认知映射等）的相关性来识别技术错误并验证模拟器和课程。合作的研究人员和机构在指标，课程，数据库开发，模拟器创建和修改以及结果分析方面具有专业知识。内窥镜鼻窦手术是操作底物，因为经常进行（每年大于300,000个程序），并且对眼睛的连续结构（视力和 /或眼睛运动的丧失）和大脑（CSF泄漏，脑膜炎，脑膜炎，死亡）有重大伤害的风险。 ES3也是现有的最先进的手术模拟设备，主要基于喷气飞行飞行模拟（洛克希德·马丁）。