Amitai Ziv

Tel Aviv University, Tell Afif, Tel Aviv, Israel

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Publications (89)210.94 Total impact

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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; DOI:10.1016/j.jbi.2015.03.004 · 2.48 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.
  • European Journal of Anaesthesiology 01/2014; 31:212. DOI:10.1097/00003643-201406001-00608 · 3.01 Impact Factor
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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
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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 · 1.55 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 · 2.60 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.
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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 · 1.45 Impact Factor
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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 · 2.91 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
  • Obstetric Anesthesia Digest 01/2013; 33(4):205-206. DOI:10.1097/01.aoa.0000436321.75864.32
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    ABSTRACT: BACKGROUND: Cardiac arrest in the parturient is often fatal, but appropriate resuscitation in this special situation may save the lives of the mother and/or unborn baby. Concern has arisen as to application of recommended techniques for resuscitation in the obstetric patient. The Israel Board of Anesthesiology has incorporated simulation assessment into accreditation examinations. The candidates represent a unique national cohort in which we were able to assess competence in the simulated scenario of cardiorespiratory arrest in the parturient. METHODS A simulated scenario of preeclampsia with magnesium toxicity leading to cardiac arrest in a pregnant patient was performed by 25 senior anesthesiology residents. A unique two-stage simulation examination consisting of high fidelity simulation followed immediately by oral debriefing was conducted. The assessment was scored using a predetermined checklist of key actions and answers to clarifying questions. Simulation performance was compared to debriefing performance. RESULTS During the board examination, resuscitation not specific to the pregnant patient was performed well (commencing chest compressions, bag-mask ventilation, cardiac defibrillation); however actions specific to the parturient were performed poorly. Left uterine displacement, cricoid pressure during bag-mask ventilation, and instructing preparations to be made for perimortem cesarean delivery within 5 minutes were performed by 68%, 48%, and 40% of candidates respectively (lower 99% confidence limit 42%, 25%, and 19%, respectively). Cricoid pressure during bag-mask ventilation was performed by 48% (25%) but described in debriefing by 80% of candidates (53%) (P = 0.08), and time setting for perimortem cesarean delivery was performed by 40% (29%) but described by 80% (53%) (P = 0.05) of examinees. CONCLUSIONS Senior anesthesiology residents have poor knowledge of resuscitation of the pregnant patient. The results suggest 2-stage simulation including an oral component may reveal disparities in knowledge not assessed by simulation alone, but definitive conclusions require further study.
    Anesthesia and analgesia 08/2012; 115(5):1122-6. DOI:10.1213/ANE.0b013e3182691977 · 3.42 Impact Factor
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    ABSTRACT: In response to current trends in healthcare education, teachers at the Michener Institute for Applied Health Sciences implemented a New Curriculum Model (NCM) in 2006, building a curriculum to better transition students from didactic to clinical education. Through the implementation of interprofessional education and simulated clinical scenarios, educators created a setting to develop, contextualize and apply students' skills before entry to the clinical environment. In this pilot study, researchers assessed the impact of the NCM intervention on student preparedness for clinical practicum. A mixed-methods evaluation was conducted, collecting survey assessments and qualitative focus group feedback from clinical educators and students. Clinical educators identified Michener NCM students to be significantly better prepared for clinical practicum when compared to previous cohorts (p < 0.05%). Students also noted significant improvements as implementation issues were resolved from years one to two of the NCM. The infusion of simulation and interprofessional education into Michener's applied health curricula resulted in a significant improvement in clinical preparedness. The Michener NCM bridged the gap previously separating didactic education and clinical practice, transitioning applied health students from trained technicians to more complete health care professionals.
    Medical Teacher 03/2012; 34(3):e176-84. DOI:10.3109/0142159X.2012.642829 · 2.05 Impact Factor
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    ABSTRACT: Assessment centres used in evaluating the non-cognitive attributes of medical school candidates must generate scores that reflect as accurate a measurement as possible of these attributes. Thus far, reliability coefficients for such centres have been based on limited samples and individual administrations, without reference to the error of variance that may result from retesting, or from the existence of multiple centres designed to measure the same attributes. The National Institute for Testing and Evaluation in Israel has developed and administered two assessment centres: MOR is used by two medical schools and one dental school, and MIRKAM by another medical school. Each centre comprises eight or nine behavioural stations, a standardised biographical questionnaire, and a judgement and decision-making questionnaire. We calculated generalisability coefficients for each centre's eight or nine stations by year, composite reliability coefficients for the overall assessment centres, test-retest correlation coefficients for repeaters, and a correlation coefficient between the centres. Between 2006 and 2009, 2662 and 2023 examinees participated in MOR and MIRKAM, respectively; 1479 of these participated in both. The average generalisability coefficients for the stations were 0.69 for MOR and 0.67 for MIRKAM. The composite reliability coefficients for the full centres (behavioural stations plus questionnaires) were 0.79 and 0.76 for MOR and MIRKAM, respectively. The correlations for repeaters, corrected for restriction of range, were 0.59 and 0.43 for MOR and MIRKAM stations, respectively, and 0.72 and 0.65 for the full MOR and MIRKAM assessments, respectively. The correlation between scores on the MOR and MIRKAM stations was 0.56 (0.75 for the overall score). The minimal reliability desirable for high-stakes decision making (0.80) was obtained only for 14 or 15 stations with questionnaires. Nevertheless, the values obtained are considerably higher than reliability coefficients for single interviews. The questionnaires contribute significantly to the accuracy of the measurement. These reliability measures constitute an upper threshold for measures of validity.
    Medical Education 03/2012; 46(3):277-88. DOI:10.1111/j.1365-2923.2011.04155.x · 3.62 Impact Factor
  • Chest 10/2011; 140(4):840-3. DOI:10.1378/chest.11-1541 · 7.13 Impact Factor
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    ABSTRACT: Although we still have much to learn about incorporating simulation into regulatory-based assessments, the authors believe that sufficient evidence exists to further advance the use of simulation-based assessments as part of the regulatory systems for healthcare professionals. This position article reviews the current use of simulation-based assessment for credentialing, licensing, and certification programs in medicine, nursing, and dentistry. The findings support the view that simulation-based assessments can make a meaningful and positive difference in credentialing, licensing, and certification programs now.
    Simulation in healthcare: journal of the Society for Simulation in Healthcare 08/2011; 6 Suppl:S58-62. DOI:10.1097/SIH.0b013e3182283bd7 · 1.59 Impact Factor

Publication Stats

2k Citations
210.94 Total Impact Points


  • 2002–2015
    • Tel Aviv University
      • Sackler Faculty of Medicine
      Tell Afif, Tel Aviv, Israel
  • 2003–2013
    • Sheba Medical Center
      • Department of Pathology
      Gan, Tel Aviv, Israel
  • 2011
    • Hebrew University of Jerusalem
      • Department of Prosthodontics
      Jerusalem, Jerusalem District, Israel
    • American Board of Internal Medicine
      Philadelphia, Pennsylvania, United States
  • 2007
    • Tel Aviv Sourasky Medical Center
      • Obstetrics Gynecology
      Tel Aviv, Tel Aviv, Israel
  • 2006
    • Ben-Gurion University of the Negev
      Be'er Sheva`, Southern District, Israel
  • 2004
    • Washington University in St. Louis
      San Luis, Missouri, United States
  • 1998–1999
    • The Children's Hospital of Philadelphia
      Filadelfia, Pennsylvania, United States