Browsing by Author "Escalona, Gabriel"
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- ItemA low-cost, DIY tourniquet simulator with built-in self-assessment for prehospital providers in Guatemala city(2024) Jhunjhunwala, Rashi; Monzon, Jose; Faria, Isabella; Escalona, Gabriel; Zinco, Analia; Ottolino, Pablo; Reyna, Favio; Raykar, Nakul; Asturias, SabrinaBackgroundHemorrhage is the leading cause of preventable death after trauma. In high-income countries first responders are trained in hemorrhage control techniques but this is not the case for developing countries like Guatemala. We present a low-cost training model for tourniquet application using a combination of virtual and physical components.MethodsThe training program includes a mobile application with didactic materials, videos and a gamified virtual reality environment for learning. Additionally, a physical training model of a bleeding lower extremity is developed allowing learners to practice tourniquet application using inexpensive and accessible materials. Validation of the simulator occurred through content and construct validation. Content validation involved subjective assessments by novices and experts, construct validation compared pre-training novices with experts. Training validation compared pre and post training novices for improvement.ResultsOur findings indicate that users found the simulator useful, realistic, and satisfactory. We found significant differences in tourniquet application skills between pre-training novices and experts. When comparing pre- and post-training novices, we found a significantly lower bleeding control time between the groups.ConclusionThis study suggests that this training approach can enhance access to life-saving skills for prehospital personnel. The inclusion of self-assessment components enables self-regulated learning and reduces the need for continuous instructor presence. Future improvements involve refining the tourniquet model, validating it with first-responder end users, and expanding the training program to include other skills.
- ItemFive-Year Experience Training Surgeons with a Laparoscopic Simulation Training Program for Bariatric Surgery: a Quasi-experimental Design(2023) Duran Espinoza, Valentina; Belmar Riveros, Francisca; Jarry Trujillo, Cristian; Gaete Danobeitia, Maria Ines; Montero Jaras, Isabella; Miguieles Schilling, Mariana; Valencia Coronel, Brandon; Escalona, Gabriel; Achurra Tirado, Pablo; Quezada, Nicolas; Crovari, Fernando; Varas Cohen, JulianPurpose Nearly 200,000 laparoscopic Roux-en-Y gastric bypass (LRYGB) are performed yearly. Reported learning curves range between 50 and 150, even 500 cases to decrease the operative risk. Simulation programs could accelerate this learning curve safely; however, trainings for LRYGB are scarce. This study aims to describe and share our 5-year experience of a simulated program designed to achieve proficiency in LRYGB technical skills.Materials and Methods A quasi-experimental design was used. All recruited participants were previously trained with basic and advanced laparoscopic simulation curriculum completing over 50 h of practical training. Ex vivo animal models were used to practice manual and stapled gastrojejunostomy (GJ) and stapled jejunojejunostomy (JJO) in 10, 3, and 4 sessions, respectively. The main outcome was to assess the manual GJ skill acquisition. Pre- and post-training assessments using a Global Rating Scale (GRS; max 25 pts), Specific Rating Scale (SRS; max 20 pts), performance time, permeability, and leakage rates were analyzed. For the stapled GJ and JJO, execution time was registered. Data analysis was performed using parametric tests.Results In 5 years, 68 trainees completed the program. For the manual GJ's pre- vs post-training assessment, GRS and SRS scores increased significantly (from 17 to 24 and from 13 to 19 points respectively, p-value < 0.001). Permeability rate increased while leakage rate and procedural time decreased significantly.Conclusion This simulated training program showed effectiveness in improving laparoscopic skills for manual GJ and JJO in a simulated scenario. This new training program could optimize the clinical learning curve. Further studies are needed to assess the transfer of skills to the operating room.
- ItemImplementing Artificial Intelligence in Physiotherapy Education: A Case Study on the Use of Large Language Models (LLM) to Enhance Feedback(2024) Villagran, Ignacio; Hernandez, Rocio; Schuit, Gregory; Neyem, Andres; Fuentes-Cimma, Javiera; Miranda, Constanza; Hilliger, Isabel; Duran, Valentina; Escalona, Gabriel; Varas, JulianThis article presents a controlled case study focused on implementing and using generative artificial intelligence, specifically large language models (LLMs), in physiotherapy education to assist instructors with formulating effective technology-mediated feedback for students. It outlines how these advanced technologies have been integrated into an existing feedback-oriented platform to guide instructors in providing feedback inputs and establish a reference framework for future innovations in practical skills training for health professions education. Specifically, the proposed solution uses LLMs to automatically evaluate feedback inputs made by instructors based on predefined and literature-based quality criteria and generates actionable textual explanations for reformulation. In addition, if the instructor requires, the tool supports summary generation for large sets of text inputs to achieve better student reception and understanding. The case study describes how these features were integrated into the feedback-oriented platform, how their effectiveness was evaluated in a controlled setting with documented feedback inputs, and the results of its implementation with real users through cognitive walkthroughs. Initial results indicate that this innovative implementation holds great potential to enhance learning and performance in physiotherapy education and has the potential to expand to other health disciplines where the development of procedural skills is critical, offering a valuable tool to assess and improve feedback based on quality standards for effective feedback processes. The cognitive walkthroughs allowed us to determine participants' usability decisions in the face of these new features and to evaluate the perceived usefulness, how this would integrate into their workload, and their opinion regarding the potential for the future within this teaching strategy. This article concludes with a discussion of the implications of these findings for practice and future research directions in this developing field.
- ItemMinimally Invasive tele-mentoring opportunity – the mito project(2019) Quezada González, José Luis; Achurra Tirado, Pablo; Jarry, Cristián; Tejos, Rodrigo; Inzunza, Martín; Ulloa, Gabriel; Neyem, Andrés; Martínez, Carlos; Martino, Carlo; Escalona, Gabriel
- ItemTaking advantage of asynchronous digital feedback: development of an at‑home basic suture skills training program for undergraduate medical students that facilitates skills retention(2023) Belmar Riveros, Francisca; Gaete Dañobeitia, María Inés; Durán Espinoza, Valentina; Chelebifski Vargas, Slavka; Jarry Trujillo, Cristián; Ortiz Koh, Catalina; Escalona, Gabriel; Villagrán Gutiérrez, Ignacio Andrés; Alseidi, Adnan; Zamorano Rivera, Elga; Pimentel Muller, Fernando; Crovari Eulufi, Fernando; Varas Cohen, Julián; Pontificia Universidad Católica de Chile. Centro de Cirugía Experimental y Simulación. Departamento de Cirugía Digestiva; Pontificia Universidad Católica de Chile. Departamento de Cirugía DigestivaPurpose to date, there are no training programs for basic suturing that allow remote deliberate practice. This study seeks to evaluate the efectiveness of a basic suture skills training program and its 6-month skill retention applying unsupervised practice and remote digital feedback. Methods Fourth-year medical-student trainees reviewed instructional videos from a digital platform and performed unsu pervised practice as needed at their homes. When they felt competent, trainees uploaded a video of themselves practicing the skill. In<72 h, they received expert asynchronous digital feedback. The course had two theoretical stages and fve video-based assessments, where trainees performed diferent suturing exercises. For the assessment, a global (GRS) and specifc rating scale (SRS) were used, with a passing score of 20 points (max:25) and 15 (max:20), respectively. Results were compared to previously published work with in-person expert feedback (EF) and video-guided learning without feedback (VGL). A subgroup of trainees underwent a 6-month skills retention assessment. Results Two-hundred and forty-three trainees underwent the course between March and December 2021. A median GRS of 24 points was achieved in the fnal assessment, showing signifcantly higher scores (p<0.001) than EF and VGL (20.5 and 15.5, respectively). Thirty-seven trainees underwent a 6-month skills retention assessment, improving in GRS (23.38 vs 24.03, p value=0.06) and SRS (18.59 vs 19, p value=0.07). Conclusion It is feasible to teach basic suture skills to undergraduate medical students using an unsupervised training course with remote and asynchronous feedback through a digital platform. This methodology allows continuous training with the repetition of quality practice, personalized feedback, and skills retention at 6 months.
- ItemTransgastric repair of transfixing gastroesophageal junction gunshot wound: video case report(2021) Vela, Javier; Contreras, Caterina; Varas, Julián; Ottolino, Pablo; Ramos, Juan Pablo; Escalona, Gabriel; Díaz, Alfonso; Achurra, Pablo; Ceroni, MarcoAbstract Managing traumatic injuries of the gastroesophageal junction (GEJ) is infrequent due to associated lesions of adjacent highly vascularized organs. Its anatomical localization in the upper abdomen makes the repair challenging to perform. A stable 23-year-old male was presented at the emergency department with two thorax gunshot wounds. Computed tomography revealed air in the periesophageal space and right hemopneumothorax with no injury of the major vessels. A chest tube was placed and the patient was transferred hemodynamically stable to the operating. Abdominal exploration identified injuries to the left diaphragm; liver lateral segment; 1-cm transfixing perforation of the GEJ and right diaphragmatic pillar. Primary repair of the GEJ was performed and patched with a partial fundoplication. The diaphragm was repaired and the liver bleeding controlled. Finally, drains and a feeding jejunostomy were placed. The patient had an uneventful early postoperative course and was discharged home on the 12th postoperative day.