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BACKGROUND: Resuscitative thoracotomies are a time-sensitive emergency surgical procedure with an immediate risk of mortality. We hypothesize that a high-fidelity whole-body donor simulation model, referred to as a Knowledge Donor (KD), with mechanical lung ventilation and expired human blood perfusion could increase learner confidence in performing this critical procedure. METHODS: General surgery residents and faculty were invited to participate in KD training. Surveys were collected to track participation and confidence. RESULTS: Simulated resuscitative thoracotomies were performed involving PGY levels I-IV. Mean confidence was highest for residents with both KD and Live Patient experience (5.6 â± â1.7), followed by Live Patient only (4.3 â± â2.5), and KD only (2.6 â± â1.3). The mean confidence rating for residents with neither training opportunity was 1.4 â± â1.0. CONCLUSIONS: The KD platform is a hyper-realistic training modality that closely replicates live surgery. This platform allows residents to practice complex surgical procedures in a safe environment, without risking patient safety. This pilot program yielded early results in improving resident procedural confidence for high-risk surgical procedures, specifically resuscitative thoracotomies.
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The objective of this article is to share how our institution implemented the use of organ donors for surgical education following organ recovery. Despite technological advances, realistic surgical simulation models are lacking, leaving little opportunity to practice a procedure prior to performance on a living patient. Utilization of organ donors following organ donation offers an opportunity for life-like surgical simulation. We developed a pathway to use organ donor tissue in the post-recovery period for robotic simulation. We obtained support from our local Institutional Review Board, Ethics Committee, and organ procurement organization to create a "knowledge donor" program. Our knowledge donation program provided learners hands-on experience with a novel procedure and also provided organ donors another opportunity to express their altruism. We found that the process was well accepted by donor families and learners. We implemented a knowledge donation program at our hospital that provides valuable surgical experience. We discuss future directions for knowledge donation at our institution.
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Answering multiple-choice questions increases accessibility of the tested information and can improve accessibility of related information. However, multiple-choice questions with "none of the above" (NOTA) as a choice hurts accessibility of the previously tested information when NOTA serves as the correct answer (NOTAcorrect). Would prompting participants to recall an answer when choosing NOTA, and then providing feedback, reduce the costs of NOTAcorrect items? In the present experiments, participants answered general knowledge questions in multiple-choice (with a NOTA alternative) or cued-recall formats; half of the participants, when choosing NOTA, were prompted to provide an answer. Half of the participants received feedback. On a final cued-recall test assessing performance for previously tested and nontested related information, we found that NOTAcorrect questions hurt performance for previously tested items as compared to the cued-recall condition; but they facilitated recall of related information. Feedback improved performance for all previously tested information, but performance was still worse for NOTAcorrect questions than for cued-recall questions. The addition of a cued-recall component on NOTA questions did not influence accessibility. The results have implications for using NOTA in practice tests and help explain why using NOTAcorrect items hurt learning, even with feedback, supporting a proactive interference account.
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Conducta de Elección , Señales (Psicología) , Evaluación Educacional , Recuerdo Mental , Adulto , Femenino , Humanos , Aprendizaje , MasculinoRESUMEN
Sickle cell disease (SCD) afflicts millions of people worldwide and is associated with considerable morbidity and mortality. Chronic and acute vaso-occlusion are the clinical hallmarks of SCD and can result in pain crisis, widespread organ damage, and early movtality. Even though the molecular underpinnings of SCD were identified more than 60 years ago, there are no molecular or biophysical markers of disease severity that are feasibly measured in the clinic. Abnormal cellular adhesion to vascular endothelium is at the root of vaso-occlusion. However, cellular adhesion is not currently evaluated clinically. Here, we present a clinically applicable microfluidic device (SCD biochip) that allows serial quantitative evaluation of red blood cell (RBC) adhesion to endothelium-associated protein-immobilized microchannels, in a closed and preprocessing-free system. With the SCD biochip, we have analyzed blood samples from more than 100 subjects and have shown associations between the measured RBC adhesion to endothelium-associated proteins (fibronectin and laminin) and individual RBC characteristics, including hemoglobin content, fetal hemoglobin concentration, plasma lactate dehydrogenase level, and reticulocyte count. The SCD biochip is a functional adhesion assay, reflecting quantitative evaluation of RBC adhesion, which could be used at baseline, during crises, relative to various long-term complications, and before and after therapeutic interventions.