Indiana University-Purdue University Indianapolis (IUPUI) / High-fidelity patient simulation (HFPS) recreates clinical scenarios by combining mock patients and realistic environments to prepare learners with practical experience to meet the demands of modern clinical practice while ensuring patient safety. This research investigated the efficacy of HFPS in medical education through a case study of the Indiana University Bloomington Interprofessional Simulation Center. The goal of this research was to understand the role of simulated learning for attaining clinical selfefficacy and how HFPS training impacts performance. Three research questions were addressed to investigate HFPS in medical education using a mixed methods study design. Clinical competence and self-efficacy were quantified among medical students at IUSMBloomington utilizing HFPS compared to two IUSM campuses that did not incorporate this instructional intervention. Clinical competence was measured as performance on the Objective Structured Clinical Examination (OSCE), while self-efficacy of medical students was measured through a validated questionnaire. Although the effect of HFPS on quantitative results was not definitive, general trends allude to the ability of HFPS to recalibrate learners’ perceived and actual performance. Additionally, perceptual data regarding HFPS from both medical students and medical residents was analyzed. Qualitative results discovered the utility of HFPS for obtaining the clinical mental framework of a physician, fundamental psychomotor skills, and essential practice communicating and functioning as a healthcare team during interprofessional education simulations. Continued studies of HFPS are necessary to fully elucidate the value of this instructional adjunct, however positive outcomes of simulated learning on both medical students and medical residents were discovered in this study contributing to the existing HFPS literature.

This is a systematic review of the research data between 1995 and June 2013 concerning faculty development in the use of high-fidelity patient simulation for health professionals and students with a search of the following databases: CINAHL, Nursing and Allied Health Collection: Comprehensive, OVID Medline, ScienceDirect, PubMed, Scopus, and ProQuest Dissertation/Theses Database. The primary search terms were high-fidelity patient simulation and faculty development. Reference lists from relevant articles were also reviewed. Twenty-five studies were included for this review. The majority of the studies were surveys with a few quasi-experimental designs. The themes were similar to those found in the non-research literature: strengths, incentives, barriers, use of faculty champions/simulation coordinator, and faculty development. The validity and reliability differed by study. There are numerous incentives and barriers to the use of high-fidelity patient simulation by faculty. Several examples of faculty development programs have been described in the literature but little evaluation has taken place beyond the end of the program. The goal of the use of high-fidelity patient simulation is to enhance the student’s knowledge, skills, and critical thinking in the care of patients. It is essential that the faculty are competent to provide instruction with high-fidelity patient simulation and therefore, the efficacy of these developmental programs need closer attention.

High Fidelity Simulation is a teaching strategy that is becoming well-entrenched in the world of nursing education and is rapidly expanding due to the challenges and demands of the health care environment. The problem addressed in this study is the conflicting research results regarding the effectiveness of HFS for students’ knowledge acquisition after participating in simulation exercises. Specifically this researcher determined the effects of a formatted simulation scenario on knowledge acquisition among nursing students and the students’ satisfaction and selfconfidence with the simulation learning activity. Kolb’s Experiential Learning Theory (1984) provided the framework for this study. This study used a quantitative quasi-experimental design, specifically, the Solomon Four Research Design with 43 first semester senior nursing students enrolled at a baccalaureate nursing program at a state university in the southeastern United States. The results of the study found that there was not a statistically significant difference between the experimental group (E1) who received HFS (z = -1.47, p = 0.143) in cognitive gains when compared to the students who did not receive the intervention of HFS (C1) (z = -1.78, p = 0.75). The students’ overall perception of HFS was very positive and the simulation activity increased their self-reported level of self-confidence. The results of this study imply that simulation should not be used with the exclusive goal to increase knowledge but rather for students to increase their confidence and to demonstrate their ability to care for a patient at the bedside. It is our duty as nurse educators to systematically evaluate new teaching efforts such as simulation to determine the effectiveness of this remarkable but expensive technology to ensure that we are providing the best learning opportunities possible for our nursing students.

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To improve the performance of the three-way catalytic (TWC) converter, advanced control strategies and onboard diagnostics (OBD) systems are needed. Both rely on a relatively accurate but computationally efficient TWC converter model. This thesis aims to develop a control-oriented model that can be employed to develop the control strategies and OBD systems of the TWC converter. The thesis consists of two parts, i.e., the high-fidelity model development and the model reduction. Firstly, a high-fidelity model is built using the energy and mass conservation principles. In this model, a constant inlet simulation is used to validate the warming-up characteristics, and a driving cycle simulation is used to calibrate the reaction rate parameters. The results of the simulation show that the high-fidelity model has adequate accuracy. Secondly, a reduced-order model is developed based on phase and reaction simplifications of the high-fidelity model. The aim of the development of the reduced-order model is to propose a computationally efficient model for further development of control strategies and state estimators for OBD systems. The accuracy of the reduced-order model is then validated by means of simulations. / Thesis / Master of Science (MSc)

To improve the performance of the three-way catalytic (TWC) converter, advanced control strategies and on-board diagnostics (OBD) systems are needed. Both rely on a relatively accurate but computationally efficient TWC converter model. This thesis aims to develop a control-oriented model that can be employed to develop the control strategies and OBD systems of the TWC converter. The thesis consists of two parts, i.e., the high-fidelity model development and the model reduction. Firstly, a high-fidelity model is built using the energy and mass conservation principles. In this model, a constant inlet simulation is used to validate the warming-up characteristics, and a driving cycle simulation is used to calibrate the reaction rate parameters. The results of the simulation show that the high-fidelity model has adequate accuracy. Secondly, a reduced-order model is developed based on phase and reaction simplifications of the high-fidelity model. The aim of the development of the reduced-order model is to propose a computationally efficient model for further development of control strategies and state estimators for OBD systems. The accuracy of the reduced-order model is then validated by means of simulations. / Thesis / Master of Applied Science (MASc)

In this dissertation, we seek to improve collision avoidance for autonomous underwater vehicles (AUVs). More specifically, we consider the case of a small AUV using a forward-looking sonar system with a limited number of beams. We describe a high-fidelity sonar model and simulation environment that was developed to aid in the design of the sonar system. The simulator achieves real-time visualization through ray tracing and approximation, and can be used to assess sonar design choices, such as beam pattern and beam location, and to evaluate obstacle detection algorithms. We analyze the benefit of using a few beams instead of a single beam for a low-cost obstacle avoidance sonar for small AUVs. Single-beam systems are small and low-cost, while multi-beam sonar systems are more expensive and complex, often incorporating hundreds of beams. We want to quantify the improvement in obstacle avoidance performance of adding a few beams to a single-beam system. Furthermore, we developed a collision avoidance strategy specifically designed for the novel sonar system. The collision avoidance strategy is based on posterior expected loss, and explicitly couples obstacle detection, collision avoidance, and planning. We demonstrate the strategy with field trials using the 690 AUV, built by the Center for Marine Autonomy and Robotics at Virginia Tech, with a prototype forward-looking sonar comprising of nine beams. / Doctor of Philosophy / This dissertation focuses on improving collision avoidance capabilities for small autonomous underwater vehicles (AUVs). Specifically, we are looking at the scenario of an AUV equipped with a forward-looking sonar system using only a few beams to detect obstacles in our environment. We develop a sophisticated sonar model and simulation environment to facilitate the design of the sonar system. Our simulator enables real-time visualization, offering insights into sonar design aspects. It also serves as a tool for evaluating obstacle detection algorithms. The research investigates the advantages of utilizing multiple beams compared to a single-beam system for a cost-effective obstacle avoidance solution for small AUVs. Single-beam sonar systems are small and affordable, while multi-beam sonar systems are more complex and expensive. The aim is to quantify the improvement in obstacle avoidance performance when adding additional sonar beams. Additionally, a collision avoidance strategy tailored to the novel sonar system is developed. This strategy, developed using a statistical model, integrates obstacle detection, collision avoidance, and planning. The effectiveness of the strategy is demonstrated through field trials using the 690 AUV, constructed by the Center for Marine Autonomy and Robotics at Virginia Tech, equipped with a prototype forward-looking sonar using nine beams.

This report describes the development, deployment, and analysis of an experimental instructional unit using applied constructivism instructional design (ID). The ID template was used to integrate a high-fidelity simulator into an undergraduate health care degree curriculum in a private, not-for-profit university. A switching-replications experimental design was used with random assignment of volunteer participants to initial treatment and control groups. Quantitative analysis of learning outcomes using standardized assessments was performed, including correlational analysis for knowledge transfer of simulator skills to clinical skills. Statistically significant positive effects were found for the educational outcomes of participants when measuring both the knowledge and application of heart anatomical structures and views for examination of the heart with ultrasound. Mild positive correlations were found between performance on the simulator and performance in an actual clinical setting, with limited predictive value between the two. The switching-replications experimental design helped to control for potentially strong social effects that could have endangered internal validity and to maximize the data available for analysis. Many of the constructivist-based ID features of the educational unit resulted in positive feedback and participation from participants. However, cautionary findings relating to the ID features included the need to carefully evaluate their use, as there was a tendency for participants to not value the performance of certain features if they were not going to be graded, despite their likely educational benefit. Future research suggested includes repetition across similar institutions with disparate student populations, and use of the educational unit ID template to implement simulation technology in other educational realms. Other possibilities include determining the effects on learning outcomes of a more-realistic user interface (UI) design and/or increased realism (difficulty) in the simulation itself. Related qualitative-based research could include structured interviews to determine participant satisfaction and learning outlooks, and investigation of the learners’ thoughts and perceptions as they use actual ultrasound machines after practicing on the simulator through think-aloud and active interview techniques.

INTRODUÇÃO: A educação neurocirúrgica requer muitos anos de treinamento prático e supervisionado. O desenvolvimento de plataformas de simulação cirúrgica é, portanto, essencial para reduzir o risco de erros intraoperatórios potencialmente graves decorrentes da inexperiência. Este estudo considera o treinamento cirúrgico para tratamento de hidrocefalia e cranioestenose. OBJETIVOS: Propor uma nova ferramenta para a educação neurocirúrgica, associando à simulação virtual e realística (realidade mista), para a correção da cranioestenose (tipo escafocefalia) e treinamento neuroendoscópico. MÉTODOS: Os simuladores físicos foram confeccionados com um silicone emborrachado termorretrátil e termossensível. Para validar os modelos de neuroendoscopia e cranioestenose, cirurgiões experientes participaram deste estudo usando vídeos de reconstrução tridimensional desenvolvidos pelo programa 3DS Max. Questionários sobre o papel dos simuladores virtuais e realísticos foram aplicados aos neurocirurgiões em relação à aplicabilidade da simulação de realidade mista para ambos os treinamentos cirúrgicos. O modelo virtual craniano foi criado com a obtenção de imagens no formato DICOM. Esta informação foi então processada usando um algoritmo de computação para gerar um biomodelo tridimensional em resina. O modelo e suas possibilidades de treinamento também foram avaliados qualitativamente por uma equipe de neurocirurgiões. Posteriormente, os especialistas avaliaram a aplicação da ferramenta para residentes em neurocirurgia. RESULTADOS: Os cirurgiões experientes consideraram a simulação mista como uma ferramenta potencial para o treinamento de novos residentes em neurocirurgia. Mais de 94% deles julgaram os simuladores adequados considerando aspectos como peso, posicionamento cirúrgico, dissecção por planos e reconstrução craniana. Em relação à experiência do modelo, cinco neurocirurgiões especialistas e 12 residentes de neurocirurgia participaram da avaliação. Todos consideraram a ferramenta positiva para o treinamento proposto. Os especialistas comentaram sobre quão interessante o modelo pode ser, instigando a compreensão das razões de cada etapa cirúrgica e de como atuar nelas. Os residentes apresentaram melhor clareza na visualização tridimensional, auxiliando indiretamente na compreensão da técnica cirúrgica. Além disso, eles notaram uma notável redução de erros em cada tentativa de montar o modelo. Os residentes consideraram ser um método de ensino cuja avaliação é objetiva e clara. CONCLUSÃO: Uma mistura de simulação física e virtual fornece previamente as habilidades psicomotoras e cognitivas necessárias, que são adquiridas apenas durante a aprendizagem prática cirúrgica. Finalmente, o quebra-cabeça pode ser uma importante ferramenta complementar, permitindo graus variados de imersão e realismo. Forneceu uma noção de realidade física, oferecendo informações dinâmicas simbólicas e geométricas, com rica visualização tridimensional. O uso de simuladores pode potencialmente melhorar e abreviar a curva de aprendizado dos cirurgiões / that requires many years of supervised hands-on training. The development of surgical simulation platforms is therefore essential to reducing the risk of potentially serious intraoperative errors arising from inexperience. This study considers the surgical training for hydrocephalus and craniosysnostosis treatment. OBJECTIVES:To propose a new tool for neurosurgical education, associating virtual and realistic simulation (mixed reality), for craniosynostosis correction (scaphocephaly type) and neuroendoscopic training. In addition, we sought to develop a \"puzzle\" to simulate the scaphocephaly surgical correction using Renier\"s \"H\" technique and to evaluate the learning impact for neurosurgery residents. METHODS: Physical simulators were made with a synthetic thermo-retractile and thermosensible silicone rubber. In order to validate the neuroendoscopy and craniosynostosis models, experienced surgeons participated in this study using tridimensional reconstruction videos developed by 3DS Max program. Questionnaires regarding the role of virtual and realistic simulators were applied to experienced neurosurgeons regarding the applicability of the mixed reality simulation for both surgery training. The puzzle cranial model was created by obtaining images through a multi slice CT scan DICOM format. This information was then processed using a computing algorithm to generate a three-dimensional biomodel in resine. The puzzle and its training possibilities were also evaluated qualitatively by a team of expert neurosurgeons. Subsequently the experts evaluated the application of the tool for residents in neurosurgery and the residents also evaluated the experience. RESULTS: The experienced surgeons considered the mixed reality simulation as a potential tool for training new residents in neurosurgery. More than 94% found the simulators appropriate considering aspects such as weight, surgical positioning, dissection by planes, and cranial reconstruction. Regarding the puzzle experience, five experts neurosurgeons and 12 neurosurgery residents participated in the evaluation. All considered the tool positive for the proposed training. The experts have commented on how interesting the model may be by instigating the understanding of the reasons for each surgical step and how to act in them. Residents presented better clarity in the three-dimensional visualization of the step by step, indirectly aiding in the understanding of the surgical technique. In addition, they noted a notable reduction of errors with each attempt to assemble the puzzle. Residents considered it to be a teaching method that makes assessment objective and clear. CONCLUSION: A mixture of physical and virtual simulation provide the required psychomotor and cognitive skills previously acquired only during practical surgical apprenticeship. Finally, puzzle in cranial shape may be an important complementary tool, allowing varying degrees of immersion and realism. It provided a notion of physical reality, offering symbolic, geometric and dynamic information, with rich tridimensional visualization. The simulators use may safely improve and abbreviate the surgeons learning curve