Research Activities

The goal of this study was to determine whether video laryngoscopy (VL) provides any advantage over direct laryngoscopy (DL) in first-attempt intubations. This was a controlled, randomized study of 120 medical students randomly assigned to either DL or VL. Each student attempted 1 endotracheal intubation on a Laerdal® Airway Management Trainer. The primary outcome measure was the time for successful endotracheal intubation. Secondary outcome measures included the incidence of esophageal intubation (EI), excess application of pressure on the maxillary incisor teeth (EMP), and first-time success rate. Mean time for endotracheal intubation was significantly faster in the VL group than in the DL group. For medical students with little or no endotracheal intubation experience, VL facilitates success and decreases the number of EIs, at least in a simulated environment.

Journal articles:

Prescher, H., Biffar, D. E., Meinke, L. E., Jarred, J. E., Brooks, A. J., & Hamilton, A. J. (2014). Video-guided versus direct laryngoscopy: Considerations for using simulation to teach inexperienced medical students. 2014 Summer Simulation Conference (SummerSim). https://doi.org/10.5555/2685617

Presentations:

Biffar D., Hamilton A. Grisham L., Jarred J., Prescher H., Brooks A., & Meinke L. (2012, January 28-30). For the inexperienced, video laryngoscopy is superior to direct laryngoscopy in the training of airway management. [Poster Abstract]. International Meeting on Simulation in Healthcare 2012, San Diego, CA.

The operating room (OR), like many other high-stress and high-stakes medical environments, can be a breeding ground for interpersonal conflict. The goal of this study was to provide an educational program on conflict resolution to 40 anesthesiology residents. The residents take a pre-assessment of their knowledge on conflict resolution before participating in the program. They then rotated through role-play and high-fidelity simulations which employ the conflict resolution skills taught in the program. A post-training assessment was used to evaluate changes in knowledge, confidence, and preparedness in conflict management strategy.

Presentations:

Theony, A., & King, J. (2022, May 4). When conflict arises in the OR: teaching anesthesiology residents conflict management strategy. [Oral presentation]. Data Blitz College of Medicine-Tucson Research Day, Tucson, AZ.

Suturing requires repeated practice with guidance to prevent skill deterioration, however, guidance is often limited by expert availability. There is evidence that augmented-reality (AR) may assist procedural skill acquisition among learners. This study examines the use of an AR suture guidance application to assist independent practice of suturing. A novel suture guidance application was designed for the Microsoft HoloLens. The guidance system included a calibration system and holograms that projected over a suture pad in step-wise manner. To assess the application, thirty medical students were recruited and randomly assigned to two groups. The control group (n=16) was given 30 minutes of independent suture practice, while the experimental group (n=14) utilized the suture guidance application. Both groups completed a pre- and post-test wound closure assessment.  After the post-test, the control group trialed the suture guidance application. All participants completed a feedback survey on the application. Both groups demonstrated a significant improvement in total time and time per stitch during the post-test. The experimental group also demonstrated significant improvement in ratio of bisecting stitches (p £0.05) and number of stitches placed (p £0.02). The feedback survey supported the application for guiding suture placement and spacing. Participants identified limitations in the hologram stability and neck positioning. This study provides evidence to support the use of augmented reality to guide independent practice of wound closure within simulation environments. 

Journal articles: 

Lovett, M., Ahanonu, E., Molzahn, A., Biffar, D., & Hamilton, A. (2024). Optimizing individual wound closure practice using augmented Reality: a randomized controlled study. Cureus. https://doi.org/10.7759/cureus.59296

Presentations: 

Lovett, M. (2018, January 13-17). Augmented reality guided wound closure application. [Showcase]. SimVentors Showcase, International Meeting on Simulation in Healthcare, Los Angeles, CA.

There are limited opportunities to practice surgical skills and techniques in residency. Therefore, it is important to explore strategies which optimize surgical simulation experiences to enhance learning outcomes and skill retention. Novice medical students (n = 29) were recruited to participate in a Fundamentals of Laparoscopic Surgery (FLS) peg transfer task training. Participants were randomly assigned to a control group, practicing the peg transfer task independently, or an experimental group, practicing with time pressure. Participant skill assessments were completed before the training, after the training, and 8-weeks after the training. Subjective and objective stress measurements were taken in the form of self-report surveys and heart rate variability data, respectively. For all the skill assessment measurements, there was no difference between groups in performance on the FLS task. Both groups showed improvement in performance after the training compared to before. The experimental group reported higher stress during and after the training period compared to the control group; however, there was no difference between groups on heart rate variability metrics. Time pressure while practicing an FLS task did not significantly impact learning acquisition or retention. However, the experimental group reported higher levels of stress. This preliminary study suggests time pressure does not confer an enhanced surgical skill learning experience for novices.

Publications:

Molzahn, A. G., Lovett, M. K., Biffar, D., De Oliveira Almeida, G., & Hamilton, A. J. (2024). The effect of time pressure on surgical skill retention in novices: a randomized controlled trial. Surgical Innovation. https://doi.org/10.1177/15533506241273359

Presentations:

Molzahn A., Lovett M., Biffar D., de Oliveira Almedia G., & Hamilton A. (2022, January 15-19). The role of sympathetic modulation on long-term retention of information during clinical simulation. [Oral Presentation]. International Meeting on Simulation in Healthcare 2022, Los Angeles, CA.

Molzahn A., Lovett A., Biffar D., de Oliveira Almedia G., & Hamilton A. (2022 May 18). The role of stress on long-term retention of information during surgical simulation. [Oral presentation].Department of Surgery Research Symposium 2022, University of Arizona, Tucson, AZ.

An emergent open thoracotomy (OT) is a high-risk, low-frequency procedure uniquely suited for simulation training. We developed a novel, cost-effective cardiothoracic (CT) surgery trainer and assessed its potential for improving technical and inter-professional skills during the course of carrying out an emergent simulated OT. We modified a commercially available mannequin torso with artificial tissue models to create a custom CT surgery trainer. The trainer’s feasibility for simulating emergent OT was tested using a multidisciplinary CT team in 3 consecutive in situ simulations. Over the course of the 3 OT simulation trials, there were dramatic reductions in the time required to perform 4 of the 5 critical milestones. A novel, low-cost CT surgery trainer was constructed for simulating emergent bedside OT in the CCU. In our preliminary evaluation, it appeared to be useful for improving team performance during a simulated OT.

Publications:

Hamilton, A. J., Prescher, H., Biffar, D. E., & Poston, R. S. (2015). Simulation trainer for practicing emergent open thoracotomy procedures. Journal of Surgical Research, 197(1), 78–84. https://doi.org/10.1016/j.jss.2015.04.037

Presentations:

Biffar, D., Poston, R., Prescher, H., Hamilton, A. (2013, January 26-30). Using interprofessional education to improve robotic cardiothoracic surgery training. [Poster Abstract]. International Meeting on Simulation in Healthcare 2013, Orlando, FL.

Biffar, D., Poston, R., Prescher, H., Hamilton, A. (2013, January 26-30). Developing a task trainer to improve interprofessional skills during robotic cardiothoracic surgery. [Poster Abstract]. International Meeting on Simulation in Healthcare 2013, Orlando, FL.

Initiation of extracorporeal membrane oxygenation (ECMO) is stressful, especially for inexperienced extracorporeal life support providers. The main objective of this study was to create a novel, reusable mannequin for high-fidelity simulation of ECMO initiation. We modified a Laerdal neonatal mannequin (SimNewB; Stavanger, Norway) so that it could be used to simulate an ECMO initiation. Questionnaire results showed that 88% of participants felt better prepared to assist in an ECMO initiation after the simulation. All participants (100%) agreed that the modified mannequin and the environment were realistic and that this simulation helps teamwork and communication in future initiations of ECMO. 

Publications:

Thompson, J. L., Grisham, L. M., Scott, J., Mogan, C., Prescher, H., Biffar, D., Jarred, J., Meyer, R. J., & Hamilton, A. J. (2014). Construction of a reusable, High-Fidelity model to enhance extracorporeal membrane oxygenation training through simulation. Advances in Neonatal Care, 14(2), 103–109. https://doi.org/10.1097/anc.0000000000000054

One of the most complex resuscitation scenarios involves the newborn with hydrops fetalis. These infants often require several quickly performed high-risk procedures such as needle thoracentesis, abdominal paracentesis, and sometimes pericardiocentesis in addition to the standard neonatal resuscitation procedures of intubation, bag and mask ventilation, chest compressions, and umbilical line placement. Existing high-fidelity neonatal simulators (such as the Laerdal SimNewB) are not presently designed to permit needle thoracentesis, abdominal paracentesis, and pericardiocentesis. We have developed a simple reusable, low-cost modification to an existing high-fidelity simulator that allows participants to obtain vital signs from the simulator while simultaneously performing the invasive procedures.

Presentations:

Livingston J. & Jarred J. (2018, January 13-17). High-fidelity simulation of the neonate with hydrops fetalis. [Poster Abstract]. International Meeting on Simulation in Healthcare 2018, Los Angeles, CA.

Emergency medicine (EM) residents are required to perform a cricothyrotomy during training as per the Accreditation Council for Graduate Medical Education (ACGME) guidelines. Cricothyrotomy is a rare procedure, comprising 0.45% of emergency department airway management procedures. Procedural competence in utilizing a realistic trainer is of utmost importance. We have developed a cricothyrotomy trainer using a fused deposition modeling (FDM) three-dimensional (3D) printer and innovative bleeding tissue to enhance fidelity. We aim to evaluate the trainer’s realism. Participants completed anonymous written surveys after performing a cricothyrotomy on the trainer. The survey evaluated the realism of the trainer and compared it to other available models by utilizing five-point visual analog scales (VAS). The participants rated their comfort level in performing the procedure pre- and post-educational lab on a five-point VAS. The innovative bleeding cricothyrotomy trainer has greater fidelity and reported superiority when compared to other commonly used nonbleeding models. This trainer provides a more advanced platform to teach an infrequent yet critical procedural skill to emergency medicine residents.

Publications:

Hughes, K. E., Biffar, D., Ahanonu, E. O., Cahir, T. M., Hamilton, A., & Sakles, J. C. (2018). Evaluation of an innovative bleeding cricothyrotomy model. Cureus. https://doi.org/10.7759/cureus.3327 

Presentations:

Livingston J. & Jarred J. (2018, January 13-17). High-fidelity simulation of the neonate with hydrops fetalis. [Poster Abstract]. International Meeting on Simulation in Healthcare 2018, Los Angeles, CA.

Peritonsillar abscess is the most common deep space infection of the head and neck presenting to emergency departments. No commercial PTA task trainer exists for simulation training. Thus, resident physicians often perform their first PTA needle aspiration in the clinical setting, knowing that carotid artery puncture and hemorrhage are serious and devastating complications. We created a cost-effective and realistic task trainer that allows trainees to acquire both diagnostic ultrasound and needle aspiration skills while draining a peritonsillar abscess. Educators from EM and otolaryngology can use this model to educate inexperienced trainees, thus ultimately improving patient safety in the clinical setting.

Publications:

Ng, V., Plitt, J., & Biffar, D. (2018). Development of a novel ultrasound-guided peritonsillar abscess model for simulation training. Western Journal of Emergency Medicine, 172–176. https://doi.org/10.5811/westjem.2017.11.36427

Presentations:

Livingston J. & Jarred J. (2018, January 13-17). Development of a novel ultrasound-guided peritonsillar abscess model for simulation training. [Poster Abstract]. International Meeting on Simulation in Healthcare 2018, Los Angeles, CA.

Plitt, J., & Ng, V. (2017, April) Development of a novel ultrasound-guided peritonsillar abscess model for simulation training. [Poster Abstract]. Council of Emergency Medicine Program Directors Academic Assembly, Fort Lauderdale, FL. 

Telepresence is emerging in clinical and educational settings as a potential modality to provide expert guidance during remote airway management. This study aimed to compare the effectiveness of telepresent versus in-person supervision of tracheal intubation. A randomized, crossover study was performed in a university medical simulation center with 48 first- and second-year medical students with no formal procedural training in tracheal intubation. Each participant was assigned to receive each of four study arms in random sequence: (1) direct laryngoscopy (DL) with in-person supervision, (2) DL with telepresent supervision, (3) videolaryngoscopy (VL) with in-person supervision, and (4) VL with telepresent supervision. In this study population of procedurally naive medical students, telepresent supervision was as effective as in-person supervision for tracheal intubation.

Publications:

Prescher, H., Grover, E., Mosier, J., Stolz, U., Biffar, D. E., Hamilton, A. J., & Sakles, J. C. (2015). Telepresent intubation supervision is as effective as In-Person supervision of procedurally naive operators. Telemedicine and E-Health, 21(3), 170–175. https://doi.org/10.1089/tmj.2014.0090 

Presentations:

Grover E., Mosier J., Sakles J., Prescher H., Biffar D., Stolz U., & Hamilton A. (2014, January 25-29). Telepresent intubation instruction is as effective as in-person when instructing naïve intubators in a simulated setting. [Poster Abstract]. International Meeting on Simulation in Healthcare 2014, San Francisco, CA.

Teamwork failures, as well as breakdowns in communication, are consistently associated with adverse events in patient care. The purpose of this study was to evaluate the effectiveness of interprofessional CPR team behavior simulation in introducing professional entry students to vital elements of interprofessional collaborative practice. In addition, this study evaluated the effectiveness of remote facilitation in comparison to live facilitation for interprofessional events and to develop a model for interactive, interprofessional CPR training at two remote sites. The interprofessional CPR team behavior simulation provided an effective platform to combine students from three Colleges in the Healthcare Sciences to emphasize the importance of interdisciplinary communication and teamwork in crisis management situations. Telesimulation with remote and live facilitation is an effective strategy to provide interprofessional simulation education.

Publications:

Collins, C., Lovett, M., Biffar, D., Hamilton, A., Holder, K., Holcomb, M., Yonsetto, P., & Weinstein, R. (2019). The use of remote and traditional faciliation to evaluate telesimulation to support interprofessional education and processing in healthcare simulation training. 2019 Spring Simulation Conference (SpringSim). https://doi.org/10.23919/springsim.2019.8732914 

Presentations:

Prescher H., Biffar D., Tomasa L., Berg M., Grisham L., Mathesen Y., Theodorou A., & Hamilton A. (2014, January 25-29). A seven-year collaboration between 3 colleges to learn interprofessional skills during a CPR team behavior simulation. [Poster Abstract]. International Meeting on Simulation in Healthcare 2014, San Francisco, CA.

Prescher H.,Biffar D., Tomasa L., Berg M., Grisham L., & Hamilton A. (2013, November 1-6). Breaking Barriers in Health Care Education: The Impact of Interprofessional CPR Training [Poster Abstract]. 2013 Association of American Medical Colleges Annual Meeting, Philadelphia, PA.

Lovett M., Biffar D., Collins C., Holder K., Holcomb M., Yonsetto P., Weinstein R., & Hamilton A. Pilot study: Evaluation of interprofessional education through telesimulation using remote and live simulation. [Poster Abstract].

The objective of the study was to examine the impact of both individual video review and completion of a formative self-assessment tool on learner participation during the debriefing of neonatal resuscitation simulations. Completing a formative self-assessment tool following a simulation exercise makes learners more actively engaged in the ensuing debriefing. Individual video review does not increase learner participation further and may not be a useful allocation of time prior to debriefing. 

Presentations:

Livingston J., Grisham L. & Biffar D. (2014, October 27). Using Tablets in Debriefing Student Performance in ASTEC [Oral Presentation]. 2014 AMES/OMSE FID Series, Tucson, AZ.

Livingston J., Prescher H., Grishamn L., & Paxton J. (2013 May 4). Using a self-assessment tool and individual video review to enhance learner participation in group debriefings of neonatal resuscitation simulations: A pilot study. [Poster Abstract]. Western Group on Education Affairs 2013, San Francisco, CA.

Livingston J., Grishamn L., & Prescher H. (2013, January 26-30). Using tablet computers to enhance learner participation in group debriefings in neonatal resuscitation program simulations: A pilot study. [Poster Abstract]. International Meeting on Simulation in Healthcare 2013, Orlando, FL.

ASTEC has developed cutting-edge computer-assisted surgical training tools, focusing on improving visualization, motion planning, and skill assessment. We studied novel technologies like multi-resolution foveated laparoscopes and virtual reality-based trainers. Additionally, we've developed advanced simulation-based systems and fuzzy logic assessments to track learning curves and evaluate performance. These innovations aim to optimize surgeon training by improving precision, feedback, and overall efficiency in minimally invasive procedures.

Publications:

Lovett, M., Biffar, D., Hamilton, A., Katz, J., Lee, S., Hua, H., & Nguyen, M. (2019). Evaluation of learning curve and peripheral awareness using a novel multiresolution foveated laparoscope. 2019 Spring Simulation Conference (SpringSim). https://doi.org/10.23919/springsim.2019.8732872 

Peng, K. S., Hong, M., Rozenblit, J., & Hamilton, A. J. (2019). Single shot state detection in Simulation-Based Laparoscopy training. 2019 Spring Simulation Conference (SpringSim). https://doi.org/10.23919/springsim.2019.8732863 

Rozenblit, J. W., Yilmaz, L., Sametinger, J., Ören, T. I., Madey, G. R., Sierhuis, M., & Antonio, Y. Z. T. U. S. (2016). Modeling of a transfer task in computer assisted surgical training. 2016 Spring Simulation Conference (SpringSim). https://dl.acm.org/doi/10.5555/2962678.2962682 

Nikodem, J., Wytyczak-Partyka, A., Klempous, R., & Rozenblit, J. (2015). Prototyping a laparoscopic skill trainer based on virtual reality and image processing. Conference on Computer Aided Systems theory. https://doi.org/10.13140/RG.2.1.1784.6641 

Rozenblit, J. W., Feng, C., Riojas, M., Napalkova, L., Hamilton, A. J., Hong, M., Berthet-Rayne, P., Czapiewski, P., Hwang, G., Nikodem, J., Shankaran, A., & Rao, A. (2014). The Computer Assisted Surgical Trainer: Design, models, and implementation (Vol. 46, Issue 10, p. 30). Society for Computer Simulation International. https://doi.org/10.5555/2685617.2685647 

Riojas, M., Feng, C., Hamilton, A., & Rozenblit, J. (2011). Knowledge elicitation for performance assessment in a computerized surgical training system. Applied Soft Computing, 11(4), 3697–3708. https://doi.org/10.1016/j.asoc.2011.01.041 

Feng, C., Rozenblit, J., & Hamilton, A. (2008). Fuzzy Logic-Based Performance Assessment in the Virtual, Assistive Surgical Trainer (VAST). 15th Annual IEEE International Conference and Workshop on the Engineering of Computer Based Systems. https://doi.org/10.1109/ecbs.2008.51

Publications- Comparison of different display modes

Katz, J., Hua, H., Lee, S., Nguyen, M., & Hamilton, A. (2022). A dual-view multi-resolution laparoscope for safer and more efficient minimally invasive surgery. Scientific Reports, 12(1). https://doi.org/10.1038/s41598-022-23021-2

Lee, S., Hua, H., Nguyen, M., & Hamilton, A. J. (2020). Further comparison of 4 display modes for a Multi-Resolution foveated laparoscope. Surgical Innovation, 28(1), 85–93. https://doi.org/10.1177/1553350620957799 

Lee, S., Hua, H., Nguyen, M., & Hamilton, A. J. (2018). Comparison of six display modes for a multi-resolution foveated laparoscope. Surgical Endoscopy, 33(1), 341–351. https://doi.org/10.1007/s00464-018-6445-0 

Prescher, H., Biffar, D. E., Rozenblit, J., & Hamilton, A. J. (2014). The comparison of high definition versus stereoscopic display on standardized fundamental laparoscopic skill procedures (Vol. 46, Issue 10, p. 48). Society for Computer Simulation International. https://doi.org/10.5555/2685617.2685665 

Feng, C., Rozenblit, J. W., & Hamilton, A. J. (2010). A computerized assessment to compare the impact of standard, stereoscopic, and high-definition laparoscopic monitor displays on surgical technique. Surgical Endoscopy, 24(11), 2743–2748. https://doi.org/10.1007/s00464-010-1038-6

 Feng, C., Rozenblit, J. W., & Hamilton, A. J. (2007). A hybrid view in a laparoscopic surgery training system. 14th Annual IEEE International Conference and Workshops on the Engineering of Computer-Based Systems. https://doi.org/10.1109/ecbs.2007.6

Publications- Motion planning and spatial navigation

Napalkova, L., Rozenblit, J. W., Hwang, G., Hamilton, A. J., & Suantak, L. (2014). An optimal motion planning method for computer-assisted surgical training. Applied Soft Computing, 24, 889–899. https://doi.org/10.1016/j.asoc.2014.08.054 

Prescher, H., Biffar, D. E., Galvani, C. A., Rozenblit, J. W., & Hamilton, A. J. (2014). Evaluation of a navigation grid to increase the efficacy of instrument movement during laparoscopic surgery. Journal of Laparoendoscopic & Advanced Surgical Techniques, 24(9), 656–659. https://doi.org/10.1089/lap.2014.0016 

Prescher, H., Biffar, D. E., Galvani, C. A., Rozenblit, J. W., & Hamilton, A. J. (2014). Surgical Navigation Pointer facilitates identification of targets in a simulated environment (Vol. 46, Issue 10, p. 35). Society for Computer Simulation International. https://doi.org/10.5555/2685617.2685652 

Feng, C., Rozenblit, J. W., Hamilton, A. J., & Wytyczak-Partyka, A. (2009). Defining spatial regions in Computer-Assisted laparoscopic Surgical training. 16th Annual IEEE International Conference and Workshop on the Engineering of Computer Based Systems. https://doi.org/10.1109/ecbs.2009.18 

Haniffa, H., Rozenblit, J., Peng, J., Hamilton, A., & Salkini, M. (2007). Motion planning system for minimally invasive surgery. 14th Annual IEEE International Conference and Workshops on the Engineering of Computer-Based Systems. https://doi.org/10.1109/ecbs.2007.56 

Feng, C., Haniffa, H., Rozenblit, J., Peng, J., Hamilton, A., & Salkini, M. (2006). Surgical training and performance assessment using a motion tracking system. 2nd European Modeling and Simulation Symposium. http://mbdl.arizona.edu/publications/pdfs/Feng2006aa.pdf

Presentations:

Feng C., Rozenblit J., & Hamilton A. (2007, February 1). Data fusion in a laparoscopic surgery training assistive system. [Poster Abstract]. Medicine Meets Virtual Reality 2007.

Huang Z., Feng C., Rozeblit J., & Hamilton A. (2011, January 23-25). Is the dominant hand always better in minimally invasive surgery? A computerized hand-eye coordination training experiment.t [Poster Abstract]. International Meeting on Simulation in Healthcare 2011, New Orleans, LA.

Prescher H., Biffar D., Galvani C., & Hamilton A. (2013, January 26-30). The comparison of high definition versus stereoscopic display on standardized Fundamental Laparoscopic Skill procedures. [Poster Abstract]. International Meeting on Simulation in Healthcare 2013, Orlando, FL.

Feng C., Huang Z., Riojas M., Rozenblit J., & Hamilton A. (2009, February 1). Usability study of computerized surgery training and assessment system. [Poster Abstract]. Medicine Meets Virtual Reality 2009.

Point-of-care ultrasound is becoming a ubiquitous diagnostic tool, and there has been increasing interest to teach novice practitioners. One of the challenges is the scarcity of qualified instructors. The purpose of our study was to determine if ultrasound-naïve operators can learn ultrasound techniques and develop the psychomotor skills to acquire ultrasound images after reviewing SonoSim® online modules. Our study findings suggest that ultrasound-naïve medical students can develop basic hands-on skills in image acquisition after reviewing online modules.

Publications:

Situ-LaCasse, E., Acuña, J., Huynh, D., Amini, R., Irving, S., Samsel, K., Patanwala, A. E., Biffar, D. E., & Adhikari, S. (2021). Can ultrasound novices develop image acquisition skills after reviewing online ultrasound modules? BMC Medical Education, 21(1). https://doi.org/10.1186/s12909-021-02612-z 

We studied the variance between self, peer, and expert assessment of a thoracostomy procedure. Our hypothesis was that self and peer assessments using the assessment tool would show no significant difference from the expert evaluation. A checklist of 25 critical steps was derived from a thoracostomy training video and then reviewed by three expert physicians to determine its validity as an assessment tool. Naïve medical students were recruited to perform one video recorded thoracostomy on a synthetic chest tube model. Each video recording was evaluated via self-assessment, peer-assessment and expert-assessment. While there were no significant differences

in the mean overall score between self, peer, and expert assessors, there was significant disagreement in the evaluation of many individual steps in the thoracostomy checklist.

Presentations:

Lovett, M., Reid, S., Prescher, H., Biffar, D., Fiorello, A., Hamilton, A. (2016, January 16-20). Development and testing of a thoracostomy assessment tool through self, peer, and expert evaluation in a simulation environment. [Poster]. International Meeting on Simulation in Healthcare 2016, San Diego, CA.

Drainage of cutaneous abscesses is a common procedure performed in emergency departments(EDs) and clinics to treat skin and soft tissue infections. The objective of this study was to develop an abscess model that accurately simulates moderate-sized abscesses with loculations that require incision and drainage and to evaluate it for use in ED resident training.  The use of the abscess model was subjectively evaluated by 1^st- through 3^rd-year residents (n=22)and attending physicians (n=2) from the Department of Emergency Medicine in a 1-hour abscess treatment and management simulation course. We developed and tested a novel, easy-to-make drain loop abscess model that can be used in a simulation training of inexperienced Emergency Medicine physicians to practice incision and drainage of cutaneous abscesses. 

Presentations:

Dreifuss B., Prescher H., & BIffar D. (2014, January 25-29). Developing a novel drain loop skin abscess model for training intern ED residents. [Poster Abstract]. International Meeting on Simulation in Healthcare 2014, San Francisco, CA. 

Ultrasound-guided percutaneous nephrolithotomy (US-PCNL) has emerged as an attractive alternative to traditional fluoroscopic PCNL. With only a limited number of training programs teaching US-PCNL, there remains a need for tools to assist with teaching this technique. The time, materials, and cost to creation of this model were recorded over 5 iterative versions. Using a 5-point visual analog scale (1e Least Realistic; 5e Most Realistic), model fidelity was assessed by: University of Arizona urology residents (n = 9), and international attending urologists experienced in US-PCNL (n = 8) at the AUA 2019 conference. This low-cost simulator provides a high-fidelity, affordable solution for teaching urologists how to perform US-PCNL.

Presentations:

Lovett M., Phung M., Biffar D., Hamilton A., Lee B., & Tzou D. (2020, May 15-18). Development of a low-cost, high-fidelity simulator for ultrasound-guided percutaneous nephrolithotomy (PCNL) training. [Poster Abstract]. American Urological Association 2020 Meeting, Washington, DC.

Pericardiocentesis is a critical, potentially life-saving procedure that is an integral part of training curriculum. However, it is a low-frequency procedure with few opportunities to practice. The objective of this study was to create a low-cost pericardiocentesis model with palpable anatomic landmarks, realistic feel, and clear ultrasound imaging that permits trainees to proceed through every critical step of the procedure. The model was trialed with Emergency Medicine and Interventional Cardiology faculty. We successfully developed a pericardiocentesis model with palpable anatomic landmarks, realistic tactile fidelity during the procedure, and clear ultrasound imaging.

Presentations:

Ng V., Prescher H., Barbosa A., Biffar D., & Hamilton A. (2017, January 28-February 1). Development of an ultrasound pericardiocentesis model for simulation training. [Oral Presentation]. International Meeting on Simulation in Healthcare 2017, Orlando, FL.

Orbital compartment syndrome (OCS) is a rare, sight-threatening emergency. Emergency physicians (EP) should be familiar with proficiently performing the lateral canthotomy and cantholysis (LCC) procedure in OCS management. However, LCC procedural teaching is not often simulated due to the lack of and access to a validated simulation model for training. In this study, we assessed the ability of a synthetic model to simulate and teach the LCC procedure to EPs and its feasibility as an alternative to the porcine model.

Presentations:

Ng V., Prescher H., Reid S., Biffar D., & Hamilton A. (2016, January 16-20). A comparison of porcine and synthetic models for lateral canthotomy and cantholysis work in progress. [Poster Abstract]. International Meeting on Simulation in Healthcare 2016, San Diego, CA.

The Department of Surgery at the University of Arizona has created an intensive laparoscopic training course for surgical residents featuring a combined simulation laboratory and live swine model. We herein report the essential components to design and implement a rigorous training course for developing laparoscopic skills in surgical residents. A multimodality intensive laparoscopic training course should become a standard requirement for surgical residents, enabling them to acquire basic and advanced laparoscopic skills on a routine basis.

Publications:

Zimmerman, H., Latifi, R., Dehdashti, B., Ong, E., Jie, T., Galvani, C., Waer, A., Wynne, J., Biffar, D., & Gruessner, R. (2011). Intensive laparoscopic training course for surgical residents: program description, initial results, and requirements. Surgical Endoscopy, 25(11), 3636–3641. https://doi.org/10.1007/s00464-011-1770-6

Presentations:

Salkini M., Johnson S., Knapp A., & Hamilton A. Simulation gains resident satisfaction in laparoscopy training. [Poster Abstract].

The objectives of this study were to determine the feasibility of integrating pre-intubation ultrasound into airway course and assess emergency medicine (EM) residents’ confidence and comfort level in using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid memraben after the training session. Pre-intubation ultrasound training was delivered to EM residents. The residents indicated how their comfort and confidence level using ultrasound for pre-intubation hemodynamic stabilization and identifying cricothyroid membrane was measured.

Publications:

Adhikari, S., Situ-LaCasse, E., Acuña, J., Irving, S., Weaver, C., Samsel, K., Biffar, D. E., Motlagh, M., & Sakles, J. (2020). Integration of Pre-intubation ultrasound into Airway Management Course: A Novel Training program. Indian Journal of Critical Care Medicine, 24(3), 179–183. https://doi.org/10.5005/jp-journals-10071-23370 

Limited clinical site availability and an increased need for clinical training experiences often make it difficult for prehospital health care providers to complete new and annual training requirements. Medical simulation provides an alternative learning environment that provides trainees the opportunity to acquire and perfect new clinical skills without compromising patient care. The air medical transport simulation was of a neonate with hypoxic ischemic encephalopathy requiring transport to a higher level of care. Patient parameters were altered during flight to simulate potential complications unique to air medical transport. Use of this training strategy is particularly beneficial for low-volume, high-risk patients, and these lessons can be applied across all age patient groups, making the experience broadly applicable.

Publications:

Grisham, L. M., Vickers, V., Biffar, D. E., Prescher, H., Battaglia, N. J., Jarred, J. E., Reid, S. A., & Hamilton, A. J. (2016). Feasibility of air Transport simulation Training: a case series. Air Medical Journal, 35(5), 308–313. https://doi.org/10.1016/j.amj.2016.02.008 

Medical simulation allows clinicians to safely practice the procedural skill of endotracheal intubation. Applied force to oropharyngeal structures increases the risk of patient harm, and video laryngoscopy (VL) requires less force to obtain a glottic view. It is unknown how much force is required to obtain a glottic view using commercially available simulation manikins and if variability exists. This study compares laryngoscopy force for a modified Cormack-Lehane (CL) grade I view in both normal and difficult airway scenarios between three commercially available simulation manikins.

Publications:

Hughes, K. E., Islam, M. T., Co, B., Lopido, M., McNinch, N. L., Biffar, D., Subbian, V., Son, Y., & Mosier, J. M. (2023). Comparison of force during the endotracheal intubation of commercial simulation Manikins. Cureus. https://doi.org/10.7759/cureus.43808