Amitai Ziv

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (98)221.62 Total impact

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    ABSTRACT: We previously developed a prototype computer-based simulation to teach residents how to integrate better EMR use in the patient-physician interaction. To evaluate the prototype, we conducted usability tests with three non-clinician students, followed by a pilot study with 16 family medicine residents. The pilot study included pre- and post-test surveys of competencies and attitudes related to using the EMR in the consultation and the acceptability of the simulation, as well as 'think aloud' observations. After using the simulation prototypes, the mean scores for competencies and attitudes improved from 14.88/20 to 15.63/20 and from 22.25/30 to 23.13/30, respectively; however, only the difference for competencies was significant (paired t-test; t=-2.535, p=0.023). Mean scores for perceived usefulness and ease of use of the simulation were good (3.81 and 4.10 on a 5-point scale, respectively). Issues identified in usability testing include confusing interaction with some features, preferences for a more interactive representation of the EMR, and more options for shared decision making. In conclusion, computer-based simulation may be an effective and acceptable tool for teaching residents how to better use EMRs in clinical encounters.
    Studies in health technology and informatics 08/2015; 216:506-510.
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    ABSTRACT: hPurpose/Objective: As electronic medical records (EMRs) become ubiquitous, concerns have been raised about their impact on patient-clinician communication. Communication has been associated with patient satisfaction, conflict resolution, adherence to treatment, and a myriad of health outcomes. Research has shown that the use of EMRs affects patient consultation various ways. On the positive side, the use of EMR improves the exchange of medical information between physicians and patients. However, it often interferes with maintaining eye contact, establishing rapport, and psychological and emotional communication. In previous research, we identified strategies and best practices employed by physicians to minimize the negative impacts and maximize the benefits of using the EMR in the clinical encounter. We built on these findings to develop a series of educational interventions. In this presentation we will describe the development of one of these interventions, a computer-based simulation, and results from a pilot study of its impact on Family Medicine residents’ skills and attitudes. Methodology/Approach: We employed the following process to develop 3 prototype computer-based simulation modules: 1. Defining the learning objectives and drafting a case synopsis (a brief narrative of the case); 2. Mapping the story by creating a flow chart of the case events with a detailed description of the actors’ actions, conversations, decisions that would be made by trainees, results of these decisions and visual elements; 3. Designing the storyboard by creating sketches of the simulation slides based on the story maps. Additionally, the storyboards include the feedback provided to the trainees based on their decisions and technical infrastructure details of developing the simulation in an authoring tool (Adobe Captivate), such as variables, standard actions, conditional actions and navigation objects; and 4. Developing the prototype in the authoring tool. We conducted a usability test of the simulation prototype with 3 Master of Information students, followed by a pilot study with 16 Family Medicine residents. The pilot study included pre- and post-test surveys of competencies and attitudes related to using the EMR in the consultation and acceptability of the simulation (based on the Technology Acceptance Model), as well as free text comments and ‘think aloud’ observation of 6 residents. Findings/Results: After using the simulation prototypes, the mean scores for both self-reported competencies and attitudes improved from 14.88±2.63 to 15.63±2.80 (M±SD; out of maximum 20 points possible) and from 22.25±2.44 to 23.13±2.16 (M±SD; out of maximum 30 points possible), respectively. The difference for competencies was significant (paired t-test; t=-2.535, p=0.023). Mean scores for perceived usefulness and ease of use of the simulation were good (3.81 and 4.10, respectively, on a 5-point scale) and intention to use the simulation and overall assessment of the session were average (3.50 and 3.16, respectively). Issues identified in usability testing include confusing interaction with some of the software features, and preferences for more interactive representation of the EMR and shared decision making opportunities. Conclusions/Implications/Recommendations: Computer-based simulation may be an effective and acceptable tool for teaching Family Medicine residents how to better use the EMR in the consultation. This potential should be further explored in future research.
    e-health 2015, Toronto, Canada; 06/2015
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    ABSTRACT: It is widely believed that electronic health records (EHR) improve medical decision-making by enabling medical staff to access medical information stored in the system. It remains unclear, however, whether EHR indeed fulfills this claim under the severe time constraints of Emergency Departments (EDs). We assessed whether accessing EHR in an ED actually improves decision-making by clinicians. A simulated ED environment was created at the Israel Center for Medical Simulation (MSR). Four different actors were trained to simulate four specific complaints and behavior and 'consulted' 26 volunteer ED physicians. Each physician treated half of the cases (randomly) with access to EHR, and their medical decisions were compared to those where the physicians had no access to EHR. Comparison of diagnostic accuracy with and without access showed that accessing the EHR led to an increase in the quality of the clinical decisions. Physicians accessing EHR were more highly informed and thus made more accurate decisions. The percentage of correct diagnoses was higher and these physicians were more confident in their diagnoses and made their decisions faster. Copyright © 2015 Elsevier Inc. All rights reserved.
    Journal of Biomedical Informatics 03/2015; 55. DOI:10.1016/j.jbi.2015.03.004 · 2.19 Impact Factor
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    ABSTRACT: Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current find-ings to support simulation in the next developmental stages.
    11/2014; 2014(5):457-467. DOI:10.2147/AMEP.S65451
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    ABSTRACT: Clinicians in Neonatal Intensive Care Units are required to perform assessments under extreme pressure to determine the illness severity of neonates. Currently there is no reference that indicates the clinical condition of a neonate according to its vital signs. Agreement between clinicians’ assessments can provide initial indication for the clinicians’ ability to systematically perform assessments. Agreement was tested between 16 clinicians who viewed 31 recorded cases and scored the illness severity of a neonate mannequin in each case. The agreement level was fair (0.28), but high correlation between the assessments (0.8<r<0.94) suggests that the clinicians were able to systematically score the cases, and they had similar interpretation about the relative illness severity between cases. Future studies are required to determine the sources for the relative low agreement level and to identify means for improvement. Establishment of a valid reference early warning score is essential to guide the assessment.
    10/2014; 58(1):783-787. DOI:10.1177/1541931214581143
  • European Journal of Anaesthesiology 06/2014; 31:212. DOI:10.1097/00003643-201406001-00608 · 2.94 Impact Factor
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    ABSTRACT: Patient education is a critical factor in the treatment of chronic disease because it reduces gaps in health care and disease management. We implemented different methods of physician training for patient education of asthma and compared the effects on patients' health. Four interventions were administered to groups of primary care physicians in one health care maintenance organization. All physicians received a list of their patients who were classified with uncontrolled asthma. Additional educational methods were implemented as follows: no additional intervention (group 1); lectures on patient education (group 2); standardized patient-based simulation training (group 3); and lectures and standardized patient-based simulations (group 4). We compared among the intervention groups and to a control group changes in rates of patients with uncontrolled asthma at 1 and 2 years after the intervention. During 1 year of follow-up, rates of uncontrolled asthma decreased from 7.2% to 6.2% (by 15%), from 7.5% to 6.5% (by 13%), from 6.4% to 5.1% (by 19%), and from 6.3% to 4.6% (by 27%) in intervention groups 1 to 4, respectively (P < 0.01). Rates decreased by approximately 7% more in all intervention groups at 2 years of follow-up. No decrease in rates was observed in the control group. An intervention for primary care physicians on educating patients with asthma to manage their disease resulted in improved patient health. The most effective intervention was the combination of lectures and standardized patient-based simulation.
    Simulation in healthcare: journal of the Society for Simulation in Healthcare 02/2014; 9(1):40-7. DOI:10.1097/SIH.0000000000000009 · 1.48 Impact Factor
  • Obstetric Anesthesia Digest 12/2013; 33(4):205-206. DOI:10.1097/01.aoa.0000436321.75864.32
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    ABSTRACT: Patient-clinician communication has been associated with patient satisfaction, compliance/ adherence and better health outcomes. Although electronic medical records (EMRs) have many benefits, one concern that remains is their impact on communication and especially on psychological and emotional exchange, establishing rapport and maintaining eye contact with the patient. In this project, we are developing a set of computer game-like simulations for enhancing family medicine residents' competence in computerized settings, based on previous research findings and modeled after a simulation-based intervention that we previously developed and tested. First, we selected an authoring tool (Adobe Captivate 7) suitable for the project. Next, we defined the design process of building computer-based simulations to include four iterative phases that we employed in developing 3 prototype scenarios. We will illustrate this process and discuss our future plans for usability evaluation and pilot testing of the simulation.
    Workshop on Interactive Systems in Healthcare (WISH) 2013, Washington, DC; 11/2013
  • Danielle Nelson · Amitai Ziv · Karim S Bandali
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    ABSTRACT: The recent technological advance of digital high resolution imaging has allowed the field of pathology and medical laboratory science to undergo a dramatic transformation with the incorporation of virtual microscopy as a simulation-based educational and diagnostic tool. This transformation has correlated with an overall increase in the use of simulation in medicine in an effort to address dwindling clinical resource availability and patient safety issues currently facing the modern healthcare system. Virtual microscopy represents one such simulation-based technology that has the potential to enhance student learning and readiness to practice while revolutionising the ability to clinically diagnose pathology collaboratively across the world. While understanding that a substantial amount of literature already exists on virtual microscopy, much more research is still required to elucidate the full capabilities of this technology. This review explores the use of virtual microscopy in medical education and disease diagnosis with a unique focus on key requirements needed to take this technology to the next level in its use in medical education and clinical practice.
    Postgraduate medical journal 10/2013; 89(1056):599-603. DOI:10.1136/postgradmedj-2012-200665rep · 1.45 Impact Factor
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    ABSTRACT: Communication skills are an important component of the neurosurgery residency training program. We developed a simulation-based training module for neurosurgery residents in which medical, communication and ethical dilemmas are presented by role-playing actors. To assess the first national simulation-based communication skills training for neurosurgical residents. Eight scenarios covering different aspects of neurosurgery were developed by our team: (1) obtaining informed consent for an elective surgery, (2) discharge of a patient following elective surgery, (3) dealing with an unsatisfied patient, (4) delivering news of intraoperative complications, (5) delivering news of a brain tumor to parents of a 5 year old boy, (6) delivering news of brain death to a family member, (7) obtaining informed consent for urgent surgery from the grandfather of a 7 year old boy with an epidural hematoma, and (8) dealing with a case of child abuse. Fifteen neurosurgery residents from all major medical centers in Israel participated in the training. The session was recorded on video and was followed by videotaped debriefing by a senior neurosurgeon and communication expert and by feedback questionnaires. All trainees participated in two scenarios and observed another two. Participants largely agreed that the actors simulating patients represented real patients and family members and that the videotaped debriefing contributed to the teaching of professional skills. Simulation-based communication skill training is effective, and together with thorough debriefing is an excellent learning and practical method for imparting communication skills to neurosurgery residents. Such simulation-based training will ultimately be part of the national residency program.
    The Israel Medical Association journal: IMAJ 09/2013; 15(9):489-92. · 0.90 Impact Factor
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    ABSTRACT: Even though Electronic Medical Records (EMRs) are increasingly used in healthcare organizations there is surprisingly little theoretical work or educational programs in this field. This study is aimed at comparing two training programs for doctor-patient-computer communication (DPCC). 36 Family Medicine Residents (FMRs) participated in this study. All FMRs went through twelve identical simulated encounters, six pre and six post training. The experiment group received simulation based training (SBT) while the control group received traditional lecture based training. Performance, attitude and sense of competence of all FMRs improved, but no difference was found between the experiment and control groups. FMRs from the experiment group evaluated the contribution of the training phase higher than control group, and showed higher satisfaction. We assume that the mere exposure to simulation served as a learning experience and enabled deliberate practice that was more powerful than training. Because DPCC is a new field, all participants in such studies, including instructors and raters, should receive basic training of DPCC skills. Simulation enhances DPCC skills. Future studies of this kind should control the exposure to simulation prior to the training phase. Training and assessment of clinical communication should include EMR related skills.
    Patient Education and Counseling 08/2013; 93(3). DOI:10.1016/j.pec.2013.08.007 · 2.20 Impact Factor
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    ABSTRACT: Although effective communication with families of critically ill patients is a vital component of quality care, training in this field is neglected. The article aims to validate communication skills training program for anesthesiology residents in the intensive care set up. Ten anesthesia residents, following 3 months of Intensive Care Unit (ICU) rotation, had 4 hours of lectures and one day simulation-based communication skills training with families of critically ill patients. Participants completed an attitude questionnaire over 3 time periods--before training [t1], immediately following training (t2) and three months following training (t3). The participants' communication skills were assessed by two blinded independent observers using the SEGUE framework while performing a simulation-based scenario at t1 and t3. Seven participants finished the study protocol. Participants ndicated communication importance as 3.68 +/- 0.58 (t1), 4.05 +/- 0.59 (t2), 4.13 +/- 0.64 (t3); their communication ability as 3.09 +/- 0.90 (t1), 3.70 +/- 0.80 (t2), 3.57 +/- 0.64 (t3); the contribution of lecture to communication 3.04 +/- 0.43 (t1), 3.83 +/- 0.39 (t2), 3.87 +/- 0.51 (t3), and contribution of simulation training to communication 3.00 +/- 0.71 (t1), 4.04 +/- 0.52 (t2), 3.84 +/- 0.31 (t3). The differences did not reach statistical significance. Objective assessment of the communication skills using the SEGUE framework indicated that 6/7 participants improved their communication skills, with communication ability before training at 2.66 +/- 0.83 and 1 month following training it was 3.38 +/- 0.78 (p = 0.09). This preliminary study demonstrates the value of communication skills training in the intensive care environment.
    Harefuah 08/2013; 152(8):453-6, 500, 499.
  • G Ben-Gal · E I Weiss · N Gafni · A Ziv
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    ABSTRACT: Virtual reality dental training simulators, unlike traditional human-based assessment, have the potential to enable consistent and reliable assessment. The purpose of this study was to determine whether a haptic simulator (IDEA Dental(®) ) could provide a reliable and valid assessment of manual dexterity. A total of 106 participants were divided into three groups differing in dental manual dexterity experience: (i) 63 dental students, (ii) 28 dentists, (iii) 14 non-dentists. The groups, which were expected to display various performance levels, were required to perform virtual drilling tasks in different geometric shapes. The following task parameters were registered: (i) Time to completion (ii) accuracy (iii) number of trials to successful completion and (iv) score provided by the simulator. The reliability of the tasks was calculated for each parameter. The simulator and its scoring algorithm showed high reliability in all the parameters measured. The simulator was able to differentiate between non-professionals and dental students or non-professionals and dentists. Our study suggests that for improved construct validity, shorter working times and more difficult tasks should be introduced. The device should also be designed to provide greater sensitivity in measuring the accuracy of the task.
    European Journal Of Dental Education 08/2013; 17(3):138-42. DOI:10.1111/eje.12023 · 0.94 Impact Factor
  • Daniel Hardoff · Nava Stoffman · Amitai Ziv
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    ABSTRACT: Alcohol consumption among youth is a major public health problem due to its association with negative outcomes which are generally preventable. Schools can play an important role in increasing health knowledge and promoting healthy behaviours that can reduce alcohol-associated risks. This paper describes and evaluates an innovative experiential project that aims to augment existing alcohol high school educational programmes. Students of 11th grade classes, age 16-17 years, participated in a one-school-day programme which included: a lecture on alcohol related risks; an enacted scenario of violent behaviour related to alcohol use; meeting with a disabled person injured in an alcohol-associated road accident, and discussion of two video movies regarding consequences of excessive alcohol drinking. The students filled a preintervention alcohol-related knowledge, attitude and practice questionnaire, a feedback questionnaire at the end of the one-day programme, and a 3-months postintervention questionnaire on their alcohol-related behaviours. 665 eleventh grade students participated in the project. The preintervention questionnaire revealed adequate knowledge on alcohol-related risks by 65% of the students. The feedback questionnaire revealed that most students felt that the programme added to their knowledge and that it might change their alcohol use behaviour. The postintervention questionnaire filled by 195 students revealed that 81% would not refrain from alcohol drinking following the project; however 47% reported consuming alcohol in moderation, and 24% specified decrease in the amount of alcoholic beverages. An experiential educational programme regarding negative outcomes of alcohol consumption resulted in reported alcohol-related behaviour change in a proportion of high school students.
    Archives of Disease in Childhood 07/2013; 98(9). DOI:10.1136/archdischild-2013-303994 · 2.90 Impact Factor
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    ABSTRACT: Background: The dentist's work requires fine manual dexterity. Virtual reality (VR) simulators, which provide real-time performance feedback, have been used in dental education for more than a decade. The reliability and validity of testing manual dexterity using the simulator was shown by the authors in previous studies. Objective: The aim of the current study was to examine the predictive validity of a VR test performed using the simulator for inexperienced students. Method: A newly developed VR simulator was used in the experiment. The user is required to perform virtual drilling tasks in various geometric shapes, while receiving force feedback based on three-dimensional images displayed on a screen. The simulator registers working time and accuracy for each task. 46 first year dental students participated in the test included 12 virtual drilling tasks. All the students had no prior dental manual experience. Later on they went on participating in a practical course consisting of drilling dental cavities using high speed. The final test of the course (12 cavity preparation) was the performance criteria for the VR test. Result: A high internal reliability was found for the test: Cronbach Alpha coefficient was 0.82. For the 46 freshmen students the Pearson correlation between the VR test and the final drilling test was 0.46 (P <0.05). Conclusion: The VR test showed a positive correlation for future performance in first year dental students. The correlation was stronger for the lower part of the class. The results support the predictive validity of the VR test and it appears that the simulator can be used as reliable tool for predicting manual dexterity for dental students. Further adjustments should be made to enable differentiating abilities in all levels of performance.
    IADR Israeli Division Meeting 2013; 06/2013
  • Amitai Ziv · Haim Berkenstadt · Orit Eisenberg
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    ABSTRACT: In the past two decades, there is a growing recognition of the power of simulation-based assessment (SBA) to serve as a complimentary method to the traditional examination methods used for licensure and certification in medical education. This chapter deals with the role SBA can and should play in regulatory-driven assessment programs. We introduce the main challenges that accompany SBA programs and suggest ways to overcome these challenges. The challenges are discussed in reference to a few key questions regarding SBA: Does SBA really simulate reality? Can SBA really measure what we want it to measure? Can examinees in SBA show their real ability? and Does SBA worth the huge investment? In the answers suggested, the keys to successful SBA are presented, with a focus on the unique multi-professional collaboration that is required for sound SBA: the collaboration between content experts, simulation experts, and measurement experts—psychometricians. Finally, the chapter describes the Israeli experience in SBA at MSR—the Israel Center for Medical Simulation—and highlights the authors’ insights from 10 years of experience in high-stakes SBA programs, such as the Israeli Board Examination in Anesthesiology, Paramedics Certification Exam, National Registration Exam for Nurse Specialists, and the “MOR” assessment center—selection of candidates to medical schools.
    The Comprehensive Textbook of Healthcare Simulation, 01/2013: pages 161-170; , ISBN: 978-1-4614-5992-7

Publication Stats

2k Citations
221.62 Total Impact Points


  • 2006–2015
    • Tel Aviv University
      • • Department of Family Medicine
      • • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
    • Ben-Gurion University of the Negev
      Be'er Sheva`, Southern District, Israel
  • 2003–2015
    • Sheba Medical Center
      Gan, Tel Aviv, Israel
  • 2011
    • Hebrew University of Jerusalem
      • Department of Prosthodontics
      Jerusalem, Jerusalem District, Israel
  • 2010
    • Imperial College London
      • Division of Surgery
      Londinium, England, United Kingdom